• Jiyun Rho, Jae Wook Lee, Yu Hua Quan, Byeong Hyeon Choi, Bong Kyung Shin, Kook Nam Han, Beop-Min Kim, Choi Young Ho YH Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea., Hwan Seok Yong, and Kim Hyun Koo HK Department of Biomedical Science, College of Medicine, Korea University, Seoul, Korea. D.
• Department of Biomedical Science, College of Medicine, Korea University, Seoul, Korea.
• Ann. Surg. 2021 May 1; 273 (5): 989-996.

ObjectiveThis study was conducted to develop a fluorescent iodized emulsion comprising indocyanine green (ICG) solution and lipiodol (ethiodized oil) and evaluate its feasibility for use in a clinical setting.BackgroundICG use for the preoperative localization of pulmonary nodules is limited in terms of penetration depth and diffusion.MethodsFirst, fluorescent microscopy was used to investigate the distribution of ICG-lipiodol emulsions prepared using different methods. The emulsions were injected in 15 lung lobes of 3 rabbits under computed tomography fluoroscopy guidance; evaluation with imaging and radiography was conducted after thoracotomy. Subsequently, the emulsions were used to preoperatively localize 29 pulmonary nodules in 24 human subjects, and wedge resections were performed using fluorescent imaging and C-arm fluoroscopy.ResultsThe optimal emulsion of 10% ICG and 90% lipiodol mixed through 90 passages had even distribution and the highest signal intensity under fluorescent microscopy; it also had the best consistency in the rabbit lungs, which persisted for 24 hours at the injection site. In human subjects, the mean diameter of pulmonary nodules was 0.9 ± 0.4 cm, and depth from the pleura was 1.2 ± 0.8 cm. All emulsion types injected were well localized around the target nodules without any side effects or procedure-related complications. Wedge resection with minimally invasive approach was successful in all pulmonary nodules with a free resection margin.ConclusionsA fluorescent iodized emulsion prepared by mixing ICG with lipiodol enabled accurate localization and resection of pulmonary nodules.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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