Indocyanine green fluorescence-guided thoracoscopic pulmonary resection for intralobar pulmonary sequestration: a case report

Abstract

Background The potential complications of pulmonary sequestration are serious and may include recurrent pulmonary infection, hemoptysis, and tumorigenesis. Therefore, the gold standard of treatment has been surgery. Although an adequate boundary between the nonfunctional lung and normal lung is required for the resection of pulmonary sequestration, the boundaries have been conventionally identified intraoperatively with inflation/deflation of the target segment by clamping and unclamping the relevant bronchus. The technique of visualizing the demarcation line based on near-infrared fluorescence imaging with indocyanine green was recently developed. Case presentation A 42-year-old Japanese woman with right Pryce III intralobar sequestration was admitted to our hospital. We planned video-assisted thoracoscopic wedge resection of the right sequestration using near-infrared fluorescence imaging with indocyanine green because of the small volume of the nonfunctional region. The aberrant artery was recognized in the pulmonary ligament; the artery was cut off after ligation. Indocyanine green at 5 mg/body was rapidly injected into the peripheral vein, and the boundary of the sequestration was clearly identified under near-infrared fluorescence imaging. Conclusion Near-infrared fluorescence imaging with indocyanine green is safe and useful for the identification of the boundary of a pulmonary sequestration.

Indocyanine green fluorescence detects the blood flow of the bronchial anastomosis for bronchoplasty “case report”

“…This report describes a first case concerning the blood distribution of the bronchial anastomosis for bronchoplasty using ICG injection under fluorescence navigation. Until now, ICG technique has been explored to create an intersegmental plane for NSCLC [ 3 ] or intralobar pulmonary sequestration [ 4 ], as we already reported.…”

“…2 ). As the result of tumor reduction after neoadjuvant chemoradiotherapy including 5 cycles of carboplatin and nab-paclitaxel and thoracic radiation therapy (50 Gy), we performed right upper sleeve lobectomy using ICG imaging as previously described [ [2] , [3] , [4] ].

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The Wide Range of Uses of Indocyanine Green in Thoracic Surgery: State of Art

“…Motohashi et al performed left basilar segmentectomy for intralobar pulmonary sequestration; they used ICG to confirm the perfusion area and abnormal blood flow governed by aberrant arteries [44]. Motono et al treated the pulmonary sequestration right video-assisted thoracoscopic wedge resection using ICG to detect the boundary between the sequestration and the normal lung [43].…”

The Wide Range of Uses of Indocyanine Green in Thoracic Surgery: State-of-the-art

“…The surgical treatment for pulmonary sequestration is resection of the non-functional area of the lung parenchyma and the ligation or cutting of the aberrant artery. The intravenous injection of ICG could help the identi cation of aberrant vessels [42,43,64,65]. ICG has been used during bronchoplasty: the success of the bronchoplasty is both tension and the blood ow, so ICG could help to evaluate the blood supply of the bronchial anastomosis [40,41].…”

“…Pulmonary sequestration blood ow governed by aberrant arteries [42]. Motono et al treated the pulmonary sequestration right video-assisted thoracoscopic wedge resection using ICG to detect the boundary between the sequestration and the normal lung [43]. One study used 0.1 mg/kg of ICG [42], while the other studies used 5 mg of ICG [64,65,43]; in all cases the administration was intravenous.…”