New technique for endobronchial targeting of the segmental bronchus during thoracoscopic segmentectomy

During thoracoscopic pulmonary segmentectomy, identification of the target segmental bronchus can occasionally be difficult. We devised a new method to overcome this difficulty. Immediately before surgery, the target segmental bronchus was marked with indocyanine green using bronchoscopy and identified intraoperatively using near-infrared fluorescence thoracoscopic imaging. Eleven consecutive patients underwent thoracoscopic segmentectomy between August 2023 and April 2024. The target segmental bronchi were successfully marked with indocyanine green in 10 cases (success rate: 90.9%) and clearly identified during surgery. In all cases, the target segmental bronchi were correctly divided without the use of intraoperative bronchoscopy; thus, the planned segmentectomies were accomplished without conversion to lobectomy. This novel technique using indocyanine green can facilitate identification of the target segmental bronchus during thoracoscopic segmentectomy.