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 (NIR)-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 indocyanine green (ICG; 0.025 mg/mL) into target subsegmental bronchi was performed under general anesthesia. The intersegmental plane was identified in real time using 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 due to initially unclear ICG delineation. Median operative time was 91.5 min (IQR: 70-120), 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 recurrence were detected on low-dose CT 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.