Indocyanine Green-Guided Thoracoscopic Pulmonary Segmentectomy in Infants

This retrospective single-center study evaluated the feasibility and safety of transbronchoscopic indocyanine green (ICG) injection for near-infrared-guided identification of the intersegmental plane during thoracoscopic pulmonary segmentectomy in infants.

Infants undergoing thoracoscopic segmentectomy for congenital lung lesions were enrolled in this retrospective single-center study. Transbronchoscopic injection of ICG (0.025 mg/mL) into target subsegmental bronchi was performed under general anesthesia. The intersegmental plane was identified in real time with a near-infrared thoracoscopic system. Feasibility was evaluated by identification accuracy, and safety was assessed by recorded complications.

The intersegmental plane was accurately identified in 76 cases (92.68%; 95% CI, 84.6%-97.0%). In 6 cases (7.32%), the modified lung inflation method was adjunctively used because of initially unclear ICG delineation. Median operative time was 91.5 minutes (interquartile range, 70-120 minutes), with negligible blood loss (4.12 ± 0.77 mL). Two cases (2.44%) developed prolonged postoperative air leakage, which resolved conservatively. No allergic reactions, tissue toxicity, or bronchial injuries were observed. During a median follow-up of 6 months, no residual lesions or recurrences were detected on low-dose computed tomography scans.

Transbronchoscopic ICG injection is a safe and effective technique for intersegmental plane identification during thoracoscopic segmentectomy in infants, providing sustained fluorescence guidance without lung hyperinflation.