Thoracoscopic anatomical lesion resection by fluorescence imaging on congenital lung malformation

Thoracoscopic anatomical lesion resection (TALR) is characteristic of removal of the lesion and preservation of all normal lung in treating congenital lung malformation(CLM). However, to conduct TALR is technically demanding for a beginner. To make the procedure easier to understand, the details for TALR are demonstrated in this report. TALR technique for CLM consisted of eight steps: step 0, ICG inhalation; step 1, mark the external lesion border; step 2, dissociate of the trunk of pulmonary vain; step 3, dissociate the pulmonary vain plane; step 4, split the parenchyma; step 5, dissect the tubular structures running into the lesion; step 6, remove the lesion; step 7, seal the wound, flush the thoracic cavity with normal saline, reinflate the lung to make sure there is no large air leak, then place 16 F chest tube. The external lesion boundary is delineated via flurorescence imaging with inhaled indocyanine green (the normal lung displays flurorescent green while the lesion hardly shows green). TALR procedure are able to split the lung along the external border combined with the internal lesion border (pulmonary vain plane), during the process, all the tubular structure including vessels and bronchi running into the lesion can be separately sealed and divided. Thereafter, complete resection of the lesion and preservation of all normal lung can be achieved. TALR procedure is characteristic of dissection of the lesion along its borders, sealing and dividing the aberrant tubular structures, then the lesion can be exclusively removed and all the normal lung preserved, which may be considered as a preferable method in treating congenital lung malformation.