BRINGING INVISIBLE TO LIGHT: OUR EXPERIENCE OF ICG IN MINIMALLY INVASIVE THORACIC SURGERIES IN RESOURCE LIMITED SETTINGS hema.siri3@gmail.com

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BRINGING INVISIBLE TO LIGHT: OUR EXPERIENCE OF ICG IN MINIMALLY INVASIVE THORACIC SURGERIES IN RESOURCE LIMITED SETTINGS

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India

Video

Indocyanine green (ICG) has gained prominence in thoracic oncology for its safety, affordability, and real-time fluorescence properties. Initially used to assess conduit vascularity, recent advances have expanded its role in delineating complex thoracic anatomy, aiding tumor localization, and minimizing surgical morbidity. We describe four emerging applications of ICG in thoracic surgery: lung nodule visualisation, bronchial visualisation, lung segment and vascular delineation, and thoracic duct identification

For intraparenchymal nodules, 2.5 mL intravenous ICG (2.5 mg/mL) enabled selective retention in nodules, facilitating minimally invasive metastasectomy. For segmentectomy, intravenous ICG (2.5 mg bolus) delineated intersegmental planes under near-infrared (NIR) imaging, avoiding the limitations of inflation–deflation, especially in emphysematous lungs. Repeated boluses remained well below the maximum recommended dose of 2 mg/kg/day. For tracheobronchial tree visualization, we administered 3 mL nebulized ICG (2.5 mg/mL) pre-intubation via standard nebulizer, achieving 100% accuracy without specialized equipment. For thoracic duct mapping, bilateral inguinal injections(0.5 mL on each side around femoral vessels) of ICG without ultrasound guidance demonstrated a 96% success rate, simplifying a traditionally complex technique.

Intravenous ICG facilitated precise nodule localization and segmental delineation, with repeated doses safely below limits. Nebulized ICG accurately visualized the tracheobronchial tree without specialized devices. Inguinal ICG injections mapped the thoracic duct with 96% success, avoiding ultrasound guidance. All techniques proved safe, feasible, and reproducible in minimally invasive thoracic surgery.

Techniques like pre-intubation nebulization and unguided inguinal injections are particularly suited to resource-limited, salvage surgery settings, demonstrating feasibility, safety, and cost-effectiveness

https://vimeo.com/1108426406/0557a84b54?share=copy