Localization of Pulmonary Nodules Using Navigation Bronchoscope and a Near-Infrared Fluorescence Thoracoscope

• Published in: The Annals of thoracic surgery Vol. 99; no. 1; pp. 224 - 230
• Main Authors: Anayama, Takashi, Qiu, Jimmy, Chan, Harley, Nakajima, Takahiro, Weersink, Robert, Daly, Michael, McConnell, Judy, Waddell, Thomas, Keshavjee, Shaf, Jaffray, David, Irish, Jonathan C., Hirohashi, Kentaro, Wada, Hironobu, Orihashi, Kazumasa, Yasufuku, Kazuhiro
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2015
• Subjects: Animals; Bronchoscopes; Bronchoscopy - methods; Cardiothoracic Surgery; Coloring Agents; Fluorescence; Indocyanine Green; Multiple Pulmonary Nodules - pathology; Surgery; Swine; Thoracoscopes; Thoracoscopy - methods; 28; 10
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.07.050

Video-assisted thoracoscopic wedge resection of multiple small, non-visible, and nonpalpable pulmonary nodules is a clinical challenge. We propose an ultra-minimally invasive technique for localization of pulmonary nodules using the electromagnetic navigation bronchoscope (ENB)-guided transbronchial indocyanine green (ICG) injection and intraoperative fluorescence detection with a near-infrared (NIR) fluorescence thoracoscope. Fluorescence properties of ICG topically injected into the lung parenchyma were determined using a resected porcine lung. The combination of ENB-guided ICG injection and NIR fluorescence detection was tested using a live porcine model. An electromagnetic sensor integrated flexible bronchoscope was geometrically registered to the three-dimensional chest computed tomographic image data by way of a real-time electromagnetic tracking system. The ICG mixed with iopamidol was injected into the pulmonary nodules by ENB guidance; ICG fluorescence was visualized by a near-infrared (NIR) thoracoscope. The ICG existing under 24-mm depth of inflated lung was detectable by the NIR fluorescence thoracoscope. The size of the fluorescence spot made by 0.1 mL of ICG was 10.4 ± 2.2 mm. An ICG or iopamidol spot remained at the injected point of the lung for more than 6 hours in vivo. The ICG fluorescence spot injected into the pulmonary nodule with ENB guidance was identified at the pulmonary nodule with the NIR thoracoscope. The ENB-guided transbronchial ICG injection and intraoperative NIR thoracoscopic detection is a feasible method to localize multiple pulmonary nodules.