Xu Hao, Wu Xun, Zhao Songjing, Wang Zhenfan, Jiang Guanchao, Li Yun, Zhou Jian
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China.
Department of Thoracic Surgery, Beijing Aerospace General Hospital, Beijing, China.
J Cardiothorac Surg. 2025 Feb 1;20(1):113. doi: 10.1186/s13019-024-03130-x.
Intraoperative tracheobronchial injury is a rare but serious complication of lung surgery. With the increasing number of segmentectomies, surgeons need to locate finer and less easily identified segmental bronchi or even subsegmental bronchi. However, there is no simple or feasible method for visualizing the bronchus during surgery.
Herein, we report a case in which indocyanine green (ICG) inhalation was used to visualize the pulmonary bronchus during video-assisted thoracoscopic surgery. The patient was a woman with a GGO located in the anterior segment of the right upper lobe, and thoracoscopic segmentectomy was scheduled. ICG (3.75 mg/ml) was inhaled into the lung on the operative side after single-lung ventilation for 5 min. During surgery, the anterior segmental bronchus was difficult to locate accurately. Under the overlay imaging window of the NIF imaging system, the bronchus was shown in green, indicating the bronchi in contrast to the surrounding lung tissue. We dissected the bronchi with the assistance of fluorescence imaging and were surprised to find that the bifurcation of the anterior and apical bronchi could be clearly identified by navigation via the inhaled ICG and NIF system. Segmentectomy was successfully performed, and no adverse events were recorded.
This case showed that ICG nebulization is feasible and safe for visualizing the pulmonary bronchus during thoracoscopic surgery. This method has great application potential for reducing intraoperative tracheobronchial injury.
术中气管支气管损伤是肺手术中一种罕见但严重的并发症。随着肺段切除术数量的增加，外科医生需要定位更精细且更难识别的肺段支气管甚至亚段支气管。然而，手术过程中尚无简单可行的支气管可视化方法。
在此，我们报告一例在电视辅助胸腔镜手术中使用吲哚菁绿（ICG）吸入来可视化肺支气管的病例。患者为一名女性，右肺上叶前段有磨玻璃影（GGO），计划行胸腔镜肺段切除术。单肺通气5分钟后，将ICG（3.75mg/ml）吸入患侧肺。手术过程中，前段支气管难以准确定位。在NIF成像系统的叠加成像窗口下，支气管显示为绿色，与周围肺组织形成对比。我们在荧光成像的辅助下解剖支气管，惊讶地发现通过吸入的ICG和NIF系统导航可以清晰地识别前段支气管和尖段支气管的分叉。成功实施了肺段切除术，未记录到不良事件。
该病例表明ICG雾化在胸腔镜手术中可视化肺支气管是可行且安全的。该方法在减少术中气管支气管损伤方面具有巨大的应用潜力。
