Precise pulmonary nodule localization, especially for deep-seated or pleural-adherent lesions, remains challenging. Conventional methods face accuracy limitations and high complication rates. This study validates a CT-guided indocyanine green (ICG)-medical adhesive composite, leveraging fluorescence stability and adhesive retention to optimize video-assisted thoracoscopic surgery (VATS) precision in complex anatomical scenarios. This retrospective single-center study evaluated a novel CT-guided preoperative localization technique combining ICG with medical adhesive in 262 patients (288 nodules). Preoperative localization was performed under CT guidance using a composite mixture of ICG and medical adhesive. The mixture was injected within 15 mm of the target nodule, and VATS was conducted with intraoperative fluorescence imaging guidance. Technical success was achieved in all cases (100%), with a mean procedural duration of 12.3 ± 4.2 min. Complications included mild pneumothorax (7.3%), self-limited hemorrhage (5.3%), and mild cough (8.0%), resolving spontaneously. The method successfully localized 57 nodules ≥ 2 cm from the pleura and 28 cases with pleural adhesions (including 7 total pleural adhesions). All nodules were resected without thoracotomy conversion. The fluorescence signal remained detectable for a maximum duration of 8 days post-localization, enabling flexible surgical scheduling. ICG-medical adhesive localization offers a safe, effective, and adaptable strategy for preoperative pulmonary nodule localization, particularly in anatomically challenging cases. Its low complication rates, sustained fluorescence, and reliability in complex scenarios support broader clinical adoption to enhance VATS precision.
Wang et al. (Fri,) studied this question.
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