Intraoperative Localization of Solid Pulmonary Tumors in Children Using Nebulized Indocyanine Green and Fluorescence Thoracoscopy
This prospective study demonstrates that preoperative nebulized indocyanine green inhalation combined with fluorescence thoracoscopy is a feasible, safe, and effective technique for achieving precise intraoperative localization of solid pulmonary tumors in children, thereby facilitating lung-sparing resections without adverse reactions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Finding a small, hidden lump inside a child's lung is one of the most delicate challenges in pediatric surgery. The goal is always the same: remove the dangerous tissue while saving as much of the healthy, growing lung as possible. Children need their full lung capacity to develop and thrive, so surgeons avoid removing entire sections unless absolutely necessary. However, once a child is asleep and the chest is opened, tiny tumors can be nearly impossible to see or feel, especially if they are buried deep inside the soft, spongy tissue. Traditional methods to mark these spots often involve needles guided by CT scans before the operation, a process that can be invasive, uncomfortable, and risky for a small patient. Surgeons have long needed a way to make these invisible targets glow or stand out clearly the moment they begin the operation, allowing for a precise, minimal cut.
A team of researchers at Huazhong University of Science and Technology has tested a new approach to solve this problem in eight children. Instead of using needles or complex external markers, they used a special dye called indocyanine green, which is safe for humans and known to light up under a specific type of camera. The innovation here was how they got the dye into the lungs. Rather than injecting it into a vein, which can sometimes wash the dye away too quickly, the doctors had the children breathe in a mist of the dye while they were awake, just before the surgery began. This mist settled directly into the lung tissue. When the surgeons later looked inside the chest with a special camera that sees near-infrared light, the tumors lit up brightly against the dark, normal lung tissue, acting like a beacon that guided the surgeon's hand.
The study involved eight children, ranging in age from one to eleven years old, who had solid growths in their lungs. These growths varied in nature; some were cancer that had spread from other parts of the body, such as the kidney or liver, while others were benign tumors or inflammatory masses. The tumors were small, with a median size of 15 millimeters, and some were located deep inside the lung, far from the surface. Before the operation, each child inhaled the mist for about fifteen to twenty minutes. Once the surgery started, the team used a thoracoscope, a thin tube with a camera, to look inside the chest. They switched the camera to a special mode that could detect the dye. In every single case, the tumor glowed clearly, showing the surgeon exactly where the healthy tissue ended and the disease began. This clarity allowed the surgeons to remove only the necessary part of the lung. Two children had a small wedge of tissue removed, five had a specific segment of the lung taken out, and only one required the removal of an entire lobe because the tumor was too large for a smaller cut.
The results were swift and clean. The surgeries took a median of thirty minutes, a short time that suggests the surgeons did not waste time searching for the hidden lumps. The children recovered quickly, staying in the hospital for a median of five and a half days. Crucially, no child experienced any bad reactions to the inhaled mist, and no complications like bleeding or infection occurred after the operation. When the researchers followed up with the families for a year, no signs of the tumors returning were found. The study suggests that breathing in this dye is a safe and effective way to help surgeons find and remove lung tumors in children with extreme precision. By making the invisible visible, this technique allows doctors to spare more of a child's healthy lung, ensuring they have the best chance for a full and healthy life after surgery.
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