Current status of various types of ICG contrast imaging in pediatric thoracic surgery.

Indocyanine green (ICG) fluorescence imaging is an emerging intraoperative navigation tool. However, its application in pediatric thoracic surgery remains to be elucidated. This review evaluates the current status and clinical utility of ICG-based imaging techniques in the field. A narrative review of studies published between January 2015 and February 2026 was conducted using PubMed, Web of Science, and Cochrane Library. Relevant original articles, reviews, and case reports were included. Data were analyzed by focusing on indications, administration methods, and clinical outcomes. Additionally, representative cases of chylothorax and congenital pulmonary airway malformations from our institution were included. Thirty-eight studies were included in this meta-analysis. ICG imaging enables real-time visualization of lymphatic leakage in chylothorax, rapid identification of intersegmental planes in pulmonary resections, and ventilation-based lesion delineation using inhaled ICG. It also supports fistula localization and perfusion assessment in patients with esophageal diseases. In oncology, ICG shows high sensitivity for detecting hepatoblastoma lung metastases, although its specificity is limited. ICG fluorescence imaging improves intraoperative visualization and precision during pediatric thoracic surgery. However, current evidence remains limited, and further standardization and prospective validation are required.