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Open Access 01-12-2018 | Research article

Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: comparison of percutaneous and bronchoscopic injection techniques

Authors: Takashi Anayama, Kentaro Hirohashi, Ryohei Miyazaki, Hironobu Okada, Nobutaka Kawamoto, Marino Yamamoto, Takayuki Sato, Kazumasa Orihashi

Published in: Journal of Cardiothoracic Surgery | Issue 1/2018

Abstract

Background

Minimally invasive video-assisted thoracoscopic surgery for small-sized pulmonary nodules is challenging, and image-guided preoperative localisation is required. Near-infrared indocyanine green fluorescence is capable of deep tissue penetration and can be distinguished regardless of the background colour of the lung; thus, indocyanine green has great potential for use as a near-infrared fluorescent marker in video-assisted thoracoscopic surgery.

Methods

Thirty-seven patients with small-sized pulmonary nodules, who were scheduled to undergo video-assisted thoracoscopic wedge resection, were enrolled in this study. A mixture of diluted indocyanine green and iopamidol was injected into the lung parenchyma as a marker, using either computed tomography-guided percutaneous or bronchoscopic injection techniques. Indications and limitations of the percutaneous and bronchoscopic injection techniques for marking nodules with indocyanine green fluorescence were examined and compared.

Results

In the computed tomography-guided percutaneous injection group (n = 15), indocyanine green fluorescence was detected in 15/15 (100%) patients by near-infrared thoracoscopy. A small pneumothorax occurred in 3/15 (20.0%) patients, and subsequent marking was unsuccessful after a pneumothorax occurred. In the bronchoscopic injection group (n = 22), indocyanine green fluorescence was detected in 21/22 (95.5%) patients. In 6 patients who underwent injection marking at 2 different lesion sites, 5/6 (83.3%) markers were successfully detected.

Conclusion

Either computed tomography-guided percutaneous or bronchoscopic injection techniques can be used to mark pulmonary nodules with indocyanine green fluorescence. Indocyanine green is a safe and easily detectable fluorescent marker for video-assisted thoracoscopic surgery. Furthermore, the bronchoscopic injection approach enables surgeons to mark multiple lesion areas with less risk of causing a pneumothorax.

Trial Registration

UMIN-CTR R000027833 accepted by ICMJE. Registered 5 January 2013.

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Title: Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: comparison of percutaneous and bronchoscopic injection techniques
Authors: Takashi Anayama
Kentaro Hirohashi
Ryohei Miyazaki
Hironobu Okada
Nobutaka Kawamoto
Marino Yamamoto
Takayuki Sato
Kazumasa Orihashi
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2018
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-018-0697-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: comparison of percutaneous and bronchoscopic injection techniques

Abstract

Background

Methods

Results

Conclusion

Trial Registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial Registration

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