Indocyanine green fluorescence guided pulmonary wedge resection in children

Abstract

Aim: Tissue diagnosis of pulmonary nodules with undetermined nature can be achieved with thoracoscopic wedge resection. However, localisation of lesion during operation can be technically demanding sometimes, especially for small deep‐seated lesions. We hereby present our experience in using indocyanine green fluorescence in guiding pulmonary wedge resection in children. Methods: Our patient is a 4 years old boy who presented with pyrexia of unknown origin associated with cough for 2 weeks. Mantoux test was positive and computer tomographic scan of thorax showed features suggestive of pulmonary tuberculosis and a 6 mm left lower lobe apical segment nodule. Lesion persisted on interval computer tomographic scan of thorax despite completion of antitubercular medications. He was referred to our surgical unit for tissue diagnosis. Results: The patient received general anesthesia and had CT guided localisation of pulmonary nodule prior to thoracoscopic wedge resection. 0.5 ml of methylene blue and 0.5 ml of indocyanine green (ICG) were injected around the lesion via an 18‐gauge guiding needle by radiologist. He was then transferred back to operation theatre for thoracoscopic resection. Thoracoscopic wedge resection of the target lesion was facilitated with the guidance of methylene blue dye and ICG fluorescence (KARL STORZ OPAL1®). The patient had uneventful recovery and was discharged 2 days after operation. Conclusion: Indocyanine green fluorescence preoperative localisation is safe and feasible. It allows a prompt and complete thoracoscopic wedge resection of small pulmonary nodule.