Near-infrared Dye Marking for Thoracoscopic Resection of Small-sized Pulmonary Nodules: Comparison of Percutaneous and Bronchoscopic Injection Techniques

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2018 Jan 14

PMID 29329549

Citations 33

Authors

Takashi Anayama

Kentaro Hirohashi

Ryohei Miyazaki

Hironobu Okada

Nobutaka Kawamoto

Marino Yamamoto

Takayuki Sato

Kazumasa Orihashi

Affiliations

Soon will be listed here.

Abstract

Background: Minimally invasive video-assisted thoracoscopic surgery for small-sized pulmonary nodules is challenging, and image-guided preoperative localisation is required. Near-infrared indocyanine green fluorescence is capable of deep tissue penetration and can be distinguished regardless of the background colour of the lung; thus, indocyanine green has great potential for use as a near-infrared fluorescent marker in video-assisted thoracoscopic surgery.

Methods: Thirty-seven patients with small-sized pulmonary nodules, who were scheduled to undergo video-assisted thoracoscopic wedge resection, were enrolled in this study. A mixture of diluted indocyanine green and iopamidol was injected into the lung parenchyma as a marker, using either computed tomography-guided percutaneous or bronchoscopic injection techniques. Indications and limitations of the percutaneous and bronchoscopic injection techniques for marking nodules with indocyanine green fluorescence were examined and compared.

Results: In the computed tomography-guided percutaneous injection group (n = 15), indocyanine green fluorescence was detected in 15/15 (100%) patients by near-infrared thoracoscopy. A small pneumothorax occurred in 3/15 (20.0%) patients, and subsequent marking was unsuccessful after a pneumothorax occurred. In the bronchoscopic injection group (n = 22), indocyanine green fluorescence was detected in 21/22 (95.5%) patients. In 6 patients who underwent injection marking at 2 different lesion sites, 5/6 (83.3%) markers were successfully detected.

Conclusion: Either computed tomography-guided percutaneous or bronchoscopic injection techniques can be used to mark pulmonary nodules with indocyanine green fluorescence. Indocyanine green is a safe and easily detectable fluorescent marker for video-assisted thoracoscopic surgery. Furthermore, the bronchoscopic injection approach enables surgeons to mark multiple lesion areas with less risk of causing a pneumothorax.

Trial Registration: UMIN-CTR R000027833 accepted by ICMJE. Registered 5 January 2013.

Citing Articles

Advantages and rational application of indocyanine green fluorescence in pulmonary nodule surgery: a narrative review.

Dai B, Yu A, Zhao G, Wang Y, Zhou Y, Ni K J Thorac Dis. 2024; 16(10):7192-7203.

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Intraoperative marking of pulmonary nodules in a hybrid operating room: electromagnetic navigation bronchoscopy versus percutaneous marking.

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Mahmutovic Persson I, Bozovic G, Westergren-Thorsson G, Rolandsson Enes S Breathe (Sheff). 2024; 20(3):230224.

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Design Optimization and Tradeoff Analysis of an Actuated Continuum Probe for Pulmonary Nodule Localization and Resection.

McCullough M, Muller M, Egan T, Buckner G Bioengineering (Basel). 2024; 11(5).

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