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Background <p>The intraoperative identification of small pulmonary nodules can be technically challenging, especially in the context of minimally invasive surgery. This study evaluates the feasibility and clinical effectiveness of preoperative percutaneous marking with a mixture of indocyanine green (ICG) and Lipiodol.</p> Methods <p>Between June 1, 2020, and May 31, 2025, 60 patients with pulmonary nodules underwent CT-fluoroscopy-guided percutaneous marking using an emulsion of 1.7&#xa0;mL Lipiodol and 0.3&#xa0;mL ICG. Surgery was performed the following day using video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracic surgery (RATS).</p> Results <p>All 60 nodules were successfully localized (100%) and resected using minimally invasive surgery. There were no localization-related complications. The median nodule size was 12.0&#xa0;mm, and the median depth from the pleura was 10.0&#xa0;mm. Segmentectomy was the most common procedure (43.3%). Conversion to thoracotomy occurred in 3.3% of cases, not related to the nodule localization. Postoperative complications occurred in 21.7% of patients, with 5.0% 90-day mortality. Final pathology revealed primary lung cancer in 75.0%, metastases in 16.7%, and benign lesions in 8.3%.</p> Conclusions <p>ICG–Lipiodol marking is a safe, effective, and practical technique for intraoperative localization of small pulmonary nodules, facilitating minimally invasive resection. The dual-modality imaging enhances surgical precision and workflow. Larger prospective studies are needed to validate these findings.</p>

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Intraoperative localization of pulmonary nodules using indocyanine green–lipiodol marking: a single-center case series

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Alessio Campisi,
  • Cinzia Bonadiman,
  • Alessandro Cipolli,
  • Daniele Autelitano,
  • Cristiano Benato,
  • Giovanni Magnanelli,
  • Giovanni Muriana,
  • Camillo Aliberti

摘要

Background

The intraoperative identification of small pulmonary nodules can be technically challenging, especially in the context of minimally invasive surgery. This study evaluates the feasibility and clinical effectiveness of preoperative percutaneous marking with a mixture of indocyanine green (ICG) and Lipiodol.

Methods

Between June 1, 2020, and May 31, 2025, 60 patients with pulmonary nodules underwent CT-fluoroscopy-guided percutaneous marking using an emulsion of 1.7 mL Lipiodol and 0.3 mL ICG. Surgery was performed the following day using video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracic surgery (RATS).

Results

All 60 nodules were successfully localized (100%) and resected using minimally invasive surgery. There were no localization-related complications. The median nodule size was 12.0 mm, and the median depth from the pleura was 10.0 mm. Segmentectomy was the most common procedure (43.3%). Conversion to thoracotomy occurred in 3.3% of cases, not related to the nodule localization. Postoperative complications occurred in 21.7% of patients, with 5.0% 90-day mortality. Final pathology revealed primary lung cancer in 75.0%, metastases in 16.7%, and benign lesions in 8.3%.

Conclusions

ICG–Lipiodol marking is a safe, effective, and practical technique for intraoperative localization of small pulmonary nodules, facilitating minimally invasive resection. The dual-modality imaging enhances surgical precision and workflow. Larger prospective studies are needed to validate these findings.