Complete Thoracoscopic Sublobar Resection for Intralobar Pulmonary Sequestration Using Indocyanine Green...

Intralobar pulmonary sequestration (IPS) is a congenital pulmonary anomaly supplied by an aberrant systemic artery. Although surgical resection is the standard treatment, complete thoracoscopic lung-preserving (sublobar) resection can be technically demanding because the border between normal and sequestrated lung may be unclear, particularly in the presence of inflammation or pleural adhesions. Indocyanine green (ICG) fluorescence imaging provides real-time perfusion-based demarcation without requiring lung inflation. We present a case of IPS treated by complete thoracoscopic sublobar resection under ICG guidance and review the literature to clarify the role of ICG in complete thoracoscopic lung-preserving surgery for IPS.

A 21-year-old man was referred after an abnormal opacity was detected on routine chest radiography. CT demonstrated a mass in the right lower lobe with an enhancing intralesional vessel. 3D-CT identified an aberrant systemic artery arising from the abdominal aorta with venous drainage into the basal pulmonary vein, consistent with IPS (Pryce type III). Thoracoscopy revealed multiple string-like pleural adhesions requiring adhesiolysis to obtain an adequate operative view. After proximal control of the aberrant systemic artery and division of the draining vein, intravenous ICG (10 mg) was administered. Fluorescence imaging clearly delineated the border between perfused normal lung and the non-perfused sequestrated area, enabling complete thoracoscopic lung-preserving resection along the demarcation line. The postoperative course was uneventful; the chest drain was removed on POD 1, and the patient was discharged on POD 9. Follow-up CT at 6 months showed no residual lesion.

This case and literature review suggest that ICG fluorescence is a practical adjunct for defining the resection line in IPS and may help maintain a complete thoracoscopic lung-preserving approach, including in selected patients with pleural adhesions, when careful patient selection and secure vascular control are ensured.