Indocyanine green (ICG) dye injection can be used to help identify nodules deep in the lung that would have been otherwise difficult to find. A surgeon can inject the ICG dye in the operating room using navigational bronchoscopy. This video presents the case of a 45-year-old female patient who underwent a robotic assisted wedge resection for a pulmonary nodule, using intraoperative navigational bronchoscopy and ICG tattoo of the nodule.
Robotic Assisted Wedge Resection for Pulmonary Nodule Using Intraoperative ICG Tattoo
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Great case. How long does ICG hang around for ? Can I ask for a radiologist to inject it by CT guidance and will it be there 4 hours later ? Presumably you had injected about 45 minutes before you went to firefly ?
Well done
What volume of ICG did you use?
Thank you for your comments and questions.
Regarding the volume of dye use just ICG, 1 to 2 ml depending on the distance between the lesion and the pleural surface, I inject direct in the area of interest.
In terms of timing, my preference is to do as expeditious as possible, takes me around 25 minutes after the injection to dock the robot. I feel 4 hours is a long time between injection and surgery but I don’t have any personal experience waiting that long. I have heard of injection of indigo carmine dye the day prior to surgery with successful localization.
I am confident that a good interventional radiologist can inject the dye in most lesions and I would expect the same results in terms of visualization, keeping in mind that pneumothorax risk is higher with percutaneous injection versus navigational bronchoscopy.
Feel free to reach out to me with any additional questions and thank you again.