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OBJECTIVE: This case video shows the image-guided VATS resection of deeply seated metastatic nodules with preoperative localization using hookwire and indocyanine green (ICG) under fluorescent video system.
METHODS: The patient was a 48-year old male who had two pulmonary metastatic nodules at left lower lobe, which were diagnosed to pulmonary metastasis from colon cancer. In this case, radiologic interventionist performed preoperative CT-guided hook-wire localization with lipiodol and ICG mixture before 1-hour from the operation.
RESULTS: We performed VATS metastasectomy with real-time visualization of the ICG fluorescence confined only around the target lung lesion. This technique enabled us to identify the pleural location of the deeply seated lung nodules. We also confirmed the resection margin with C-arm fluoroscopy. The lipiodol was useful to prevent the spread of less viscous fluorescence material (ICG) after localization.
CONCLUSIONS: Fluorescent surgical video system enables image-guided VATS resection of deeply seated lung nodule with real-time visualization of the pleural location and adequate resection margin with C-arm fluoroscopy.