J.Jpn. Surg. Soc.. 121(1): 48-53, 2020

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INDOCYANINE GREEN FLUORESCENCE-NAVIGATED THORACIC SURGERY: STUDIES AND PROSPECTS

With the widespread use of computed tomography screening for lung cancer, the detection rate of small-sized lung cancer has increased. Likewise, in an increasingly aging society, the proportion of elderly patients undergoing lung cancer surgery has continued to rise. Consequently, the role of minimally invasive surgery for lung cancer has expanded. Although the standard procedure for primary lung cancer remains lobectomy with hilar and mediastinal lymph node dissection, less-invasive procedures, such as sublobar resection and selective lymph node dissection, are performed in selected patients. Near-infrared imaging with indocyanine green (ICG) plays an important role in performing minimally invasive surgery. First, preoperative localization of small indistinct tumors with intravenous injection of ICG is effective because this method does not cause serious complications, such as air embolism, that can develop after transthoracic lung puncture. Second, ICG is useful in determining the intersegmental line during anatomic segmentectomy. This method can be used without a bronchoscopic procedure and thus can be applied in patients with pulmonary emphysema. Finally, ICG can be used to locate lymphatic drainage from the primary tumor. ICG-based lymphography may contribute to a better understanding of the sentinel node concept in lung cancer as well as the mechanisms of skip metastasis.

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