Indocyanine Green-Soaked Microcoil Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery: A Feasibility Study
2Department of Medical Imaging, Soroka University Medical Center, Israel
Background: The increasing use of chest CT has led to greater detection of small pulmonary nodules requiring surgical excision. During video-assisted thoracoscopic surgery (VATS), limited tactile feedback can make localization of small, deep, or subsolid nodules challenging, often necessitating preoperative localization. Conventional microcoil localization commonly relies on intraoperative fluoroscopy, adding radiation exposure and the need for fluoroscopy equipment in the operating room. We evaluated whether indocyanine green (ICG)-soaked microcoils enable pulmonary nodule localization during VATS without intraoperative fluoroscopy.
Methods: In this retrospective single-center cohort study, patients who underwent CT-guided pulmonary nodule microcoil localization before VATS between December 2024 and March 2026 were reviewed. Microcoils were soaked in 0.25–0.5 mL of ICG solution (2.5 mg/mL) before percutaneous deployment under CT guidance using a coaxial technique. Nodules were localized intraoperatively using near-infrared fluorescence imaging. The primary outcome was successful localization without intraoperative fluoroscopy in the ICG group. Secondary outcomes were compared with conventional microcoil controls.
Results: Sixty-five patients were analyzed: 33 in the ICG group (mean age, 66±13 years; 64% female) and 32 controls (65±14 years; 44% female). Median nodule size was 11.5 mm (IQR, 7.4–14.5) versus 10.5 mm (IQR, 8–12), and median depth was 3 mm (IQR, 1–11) versus 4 mm (IQR, 0–12.5), respectively (p>0.05). Fluoroscopy-free localization was achieved in 64% (21/33) of ICG cases. Complete target-lesion resection was achieved in 97% of patients in both groups. CT-guided procedure time, interval to surgery, operative duration, hospital stay, additional resection, and complication rates were similar between groups (all p>0.05).
Conclusion: ICG-soaked microcoil localization is feasible and may reduce dependence on intraoperative fluoroscopy during VATS, with the potential to reduce radiation exposure and simplify operating-room workflow while maintaining outcomes comparable to conventional microcoil localization.