Case Report: Indocyanine Green Injection into the Bronchial Wall Was Useful as a Central Side Marker in Resecting Small Lung Cancer

Abstract

Background. Markers are required for partial resection of tumors that are difficult to identify intraoperatively. Virtual-assisted lung mapping (VAL-MAP) achieves simultaneous multiple mapping on the lung surface, enabling the resection range to be simulated more accurately than with conventional marking. Indocyanine green (ICG) gives good visibility as the dye used in VAL-MAP. However, since VAL-MAP cannot be used as a central side marker, there is a risk of the surgical margin of the central side closing. We attempted to use ICG injected into the bronchial wall as a central side marker. Case. In an 87-year-old woman who had undergone right lung S¹⁺²a segmentectomy for adenocarcinoma six years earlier, a new ground-glass nodule appeared, and wedge resection was planned for the diagnosis and treatment. Three mappings were placed on the lung surface using ICG-VAL-MAP, and ICG was injected into the bronchial wall of B⁴b on the central side of the tumor. During the operation, the bronchial-injected ICG was confirmed in the interlobar fissure with near-infrared fluorescence imaging, and wedge resection was performed using this as a deep marker. The resection margin was 2.2 cm. No adverse events were observed. Conclusion. ICG injected into the bronchial wall can serve as a central side marker.