A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green

J Thorac Cardiovasc Surg. 2012 Jun;143(6):1330-5. doi: 10.1016/j.jtcvs.2012.01.079. Epub 2012 Feb 22.


Objective: Pulmonary segmentectomy has been recognized as an operative option for complete resection of early-stage lung cancer in patients with poor pulmonary function. However, identification of anatomic pulmonary segments is sometimes difficult in patients with emphysema. We developed an intraoperative method for identifying intersegmental planes of the lung with high-sensitivity infrared fluorescence imaging after transbronchial injection of indocyanine green.

Methods: The study included 10 patients with early-stage lung cancer who underwent thoracoscopic segmentectomy. Under general anesthesia, indocyanine green was injected into the bronchus of target pulmonary segments. The target segments of the lung were identified using the indocyanine green fluorescence endoscope (Hamamatsu Photonics, Hamamatsu, Japan). The intersegmental lines and planes were identified and allowed removal of the segments. To evaluate operative outcomes, we compared the indocyanine green injection group with a retrospective control group with 10 matched-pair patients who underwent traditional thoracoscopic segmentectomy.

Results: Accurate, real-time intraoperative detection of indocyanine green with an infrared thoracoscope was confirmed. Sparing of intersegments was safely performed using both staples and electric cautery. Furthermore, infrared thoracoscopy allowed visualization of any residual portion of resected segments after segmentectomy. There was no difference between the experimental indocyanine green and control groups in terms of operative time, duration of postoperative chest drainage, or postoperative complications. Length of stay was shorter in the indocyanine green group than in the control group (P = .055).

Conclusions: Transbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy.

Publication types

  • Video-Audio Media

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Equipment Design
  • Female
  • Fluorescence
  • Fluorescent Dyes* / administration & dosage
  • Humans
  • Indocyanine Green* / administration & dosage
  • Infrared Rays*
  • Intraoperative Care
  • Japan
  • Length of Stay
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pneumonectomy* / adverse effects
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Predictive Value of Tests
  • Retrospective Studies
  • Thoracoscopes
  • Thoracoscopy / instrumentation
  • Thoracoscopy / methods*
  • Time Factors
  • Treatment Outcome


  • Fluorescent Dyes
  • Indocyanine Green