A New Method to Identify Air Leaks After Pulmonary Resection Using Indocyanine Green Aerosol

This study investigated whether air leak sites resulting from pulmonary resection could be identified by the administration of aerosolized indocyanine green into the airway.

Sixty-one patients who underwent lung resection surgery (54 video-assisted thoracoscopic surgeries and 7 thoracotomies) during 2019 to 2021 were enrolled. An additional sealing test including indocyanine green administration and observation with a near-infrared camera was performed after the conventional sealing test. The results of the indocyanine sealing test were compared with those of the conventional sealing test and evaluated. The observation period set for evaluating adverse events was 1 month.

The conventional sealing test detected 38 air leak points, of which 20 were caused by stapler-related pleural defects. The indocyanine green sealing test identified 55 indocyanine green fluorescent sites. Among these, 37 sites were matched with air leak points identified in the conventional sealing test, and 18 new sites were identified in the indocyanine green test. Reexamination of newly identified indocyanine green fluorescent sites with the conventional sealing test showed 13 air leak sites additionally. The detection rate of the conventional sealing test was 75% and that of the indocyanine green sealing test was 98% (P = .001). No complications attributable to the aerosolized indocyanine green were encountered.

The indocyanine green sealing test could identify air leak points overlooked by the conventional method. This procedure may be suitable in video-assisted surgery to improve surgical field visibility, and it allows prolonged observation of the lung in a collapsed state.