Inhaled indocyanine green in thoracoscopic resection of segmental congenital pulmonary malformations: A novel technique enabling a lobe-sparing approach.

BACKGROUND

Congenital lung malformations encompass a variety of abnormal pulmonary lesions, including congenital pulmonary airway malformations and bronchopulmonary sequestrations. Congenital lung malformation margins can be difficult to detect for complete resection. Therefore, inhaled indocyanine green has been utilized to visualize lesion borders. We report a novel, intraoperative technique of indocyanine green administration in the pediatric population to establish feasibility in facilitating thoracoscopic segmental lung resections.

METHODS

We conducted a retrospective review from December 2024 to September 2025 of pediatric patients who underwent intraoperative inhaled indocyanine green during thoracoscopic resections. Indocyanine green solution (0.5 mg/kg) was administered after induction and intubation via nebulizer through the endotracheal tube prior to single lung ventilation. Patients were matched in a 1:1 ratio, and patient demographics, perioperative, and postoperative data were compared.

RESULTS

Eight children received inhaled indocyanine green intraoperatively during thoracoscopic lung resections. Inhaled indocyanine green guidance assisted in 4 lobe-sparing segmentectomies. The median age at surgery was 8.8 (interquartile range, 7.2-15.4) months. Median total time spent in the operating room was 309 (interquartile range, 188.5-409.5) minutes, with a median operating time of 199.5 (interquartile range, 92.8-252.8) minutes. The median length of chest tube duration was 2 (interquartile range, 1.8-2) days. The median length of stay was 2 (interquartile range, 2-2.3) days. When compared with the matched controls, there were no statistical differences in operative time, in-room time, chest tube duration, or length of stay.

CONCLUSION

Intraoperative administration of inhaled indocyanine green is feasible, with avidity correlating with preoperative imaging. Thoracoscopic segmentectomy was completed with similar perioperative outcomes to matched controls. Inhaled indocyanine green may facilitate lobe-sparing pulmonary resection in select patients.