Indocyanine green-guided thoracoscopic wedge resection for pulmonary sequestration

This video tutorial demonstrates a right-sided video-assisted thoracoscopic surgery approach for the management of an intralobar pulmonary sequestration in an adult. Although conservative or endovascular approaches exist, surgical resection is recommended to prevent recurrent infections and mitigate the risk of malignant transformation. While anatomical lobectomy has traditionally been the standard, lung-sparing techniques are increasingly preferred to preserve pulmonary function. The procedure emphasizes the isolation and division of the aberrant systemic arterial supply arising from the descending aorta, mitigating haemorrhagic risks. Subsequently, intravenous indocyanine green is administered to achieve real-time, high-contrast near-infrared fluorescence demarcation of the non-perfused sequestered lung tissue. Guided by this distinct intersegmental boundary, a precise parenchymal-sparing wedge resection of the right lower lobe is performed. Final indocyanine green assessment confirms adequate perfusion of the remaining parenchyma and complete resection with negative margins. This approach ensures definitive treatment while optimizing functional outcomes.