Identifying the Target Segmental Bronchus Using Near-infrared Fluorescence in Thoracoscopic Segmentectomy: A Case Report

Identifying the target segmental bronchus during thoracoscopic segmentectomy can be challenging sometimes. We devised a novel method that uses near-infrared fluorescence imaging to overcome this difficulty. A 76-year-old man was admitted with suspected lung cancer; he presented with a 1.2 cm solid nodule in the left S1+2 segment. Thoracoscopic left S1+2 segmentectomy was planned. The target segmental bronchus was marked with indocyanine green via a bronchoscope immediately before surgery and after tracheal intubation under general anesthesia. The segmental artery, bronchus, and vein are usually divided in order during a segmentectomy. However, in this case, the first division of the segmental artery (A1+2c) was impossible due to an adherent anthracosilicotic lymph node. Therefore, the identification of the segmental bronchus (B1+2) was required before the division of the segmental artery and was performed using indocyanine green during thoracoscopy. Although converted thoracotomy was needed to divide the pulmonary artery, the left S1+2 segmentectomy was accomplished. The resected tumor was pathologically diagnosed as a squamous cell carcinoma. The postoperative drainage period and length of hospital stay were 1 and 5 days, respectively. There were no complications related to the use of indocyanine green. This novel method, using near-infrared fluorescence imaging, can help identify the target segmental bronchus during thoracoscopic segmentectomy.