Segmental bronchial marking method using indocyanine green for safe thoracoscopic segmentectomy: a single-center early experience.

Background: Segmentectomy is an acceptable surgical procedure for the treatment of small-sized lung cancers or pulmonary metastases. Among the segmentectomies, performing complex segmentectomies is challenging because of the deep intraparenchymal localization of the hilar structures and the presence of anatomical variations. Particular attention should be paid to avoid intraoperative bronchial misidentification. Therefore, it might be enhancing the precision of segmentectomy through preoperative marking of the segmental bronchus. Here, we sought to investigate the safety and postoperative outcomes of thoracoscopic surgery for segmentectomy upon segmental bronchial marking using indocyanine green (ICG).

Methods: We retrospectively analyzed data obtained from the medical records of patients who underwent thoracoscopic segmentectomy, including sub-segmentectomy, between April 2023 and January 2025. Bronchial marking with ICG was initiated in October 2023. Segmental bronchial marking was performed under general anesthesia before surgery. Bronchoscopy was performed and the target segmental bronchus was identified. ICG and air were sprayed into the target bronchus. The segmental bronchus could be identified using ICG fluorescence during thoracoscopic surgery.

Results: Forty-four patients with video- or robot-assisted thoracoscopic surgery underwent bronchial marking. No adverse events or postoperative complications due to preoperative bronchial marking were identified. One patient (2.3%) underwent a different segmentectomy than that planned.

Conclusions: This segmental bronchial marking method for intraoperative segmental bronchial identification using ICG is safe and feasible for segmentectomy. It may be useful in cases of complex or challenging segmentectomies via thoracoscopic surgery.