Preoperative nebulized indocyanine green-assisted thoracoscopic anatomical lesion resection for congenital pulmonary airway malformations in children: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 SHI Hongguang , WANG Jiaxi , SUN Peiliang , CHEN Zhenqiu , ZHANG Weibo , FU Zhe , ZHENG Mingjun , MA Yongqian

Department of Pediatric Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China;

Corresponding?author：

SHI Hongguang, Email: xinxianyu@163.com

Keywords：

Thoracoscopy; congenital pulmonary airway malformation; indocyanine green; anatomical lesion resection; child

DOI：

10.7507/1007-4848.202509017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the efficacy of preoperative nebulized indocyanine green (ICG)-assisted thoracoscopic anatomical lesion resection (TALR) in treating pediatric congenital pulmonary airway malformation (CPAM). Methods A retrospective analysis was conducted on clinical data of 45 children with CPAM who underwent thoracoscopic surgery at the Third Affiliated Hospital of Zhengzhou University between June 2023 and March 2025. The patients were divided into an ICG group (preoperative nebulized ICG 0.5 mg/kg+TALR) and a non-ICG group (TALR under white light), with perioperative and postoperative recovery parameters compared between groups. Results A total of 45 children [22 males, 23 females; median age 7.4 (1.1-75.0) months] were enrolled. The ICG group (n=22) and non-ICG group (n=23) both achieved uneventful recoveries. Compared to the non-ICG group, the ICG group demonstrated significantly shorter surgical duration [91.3 (38.0, 144.0) min vs. 100.0 (50.0, 175.0) min, P=0.032], reduced intraoperative blood loss [3.0 (2.0, 10.0) mL vs. 5.0 (1.0, 10.0) mL, P=0.049], shorter postoperative drainage duration [2.7 (1.9, 3.9) d vs. 3.4 (1.8, 19.9) d, P=0.003], and shortened hospital stay [4.6 (2.9, 9.8) d vs. 5.0 (3.9, 21.5) d, P=0.013]. Residual lesions occurred in 2 patients from the non-ICG group but none in the ICG group. Intragroup comparisons revealed significant improvements in peak inspiratory flow ratio, tidal volume ratio, and normalized tidal volume per kilogram after surgery in both groups (P<0.05), though intergroup differences showed no statistical significance (P>0.05). Conclusion Preoperative nebulized ICG administration facilitates lesion identification in CPAM, reduces technical difficulty of TALR, enhances therapeutic outcomes, and provides valuable assistance for performing TALR procedures.

1.	Dehner LP, Schultz KAP, Hill DA. Congenital pulmonary airway malformations with a reconsideration and current perspective on the Stocker classification. Pediatr Dev Pathol, 2023, 26(3): 241-249.
2.	中華醫學會小兒外科學分會普胸外科學組, 中國醫療保健國際交流促進會婦兒醫療保健分會. 先天性肺氣道畸形診療中國專家共識(2021版). 中華小兒外科雜志, 2021, 42(8): 679-687.Section of General Thoracic Surgery, Branch of Pediatric Surgery, Chinese Medical Association; Branch of Women and Children's Medical Care, China International Exchange and Promotive Association for Medical and Health Care. National expert consensus on diagnosis & treatment of congenital pulmonary airway malformations in China (2021). Chin J Pediatr Surg, 2021, 42(8): 679-687.
3.	Huang JX, Hong SM, Hong JJ, et al. Medium-term pulmonary function test after thoracoscopic lobectomy and segmentectomy for congenital lung malformation: a comparative study with normal control. Front Pediatr, 2021, 9: 755328.
4.	Liao J, Lin M, Zeng J, et al. Prognosis of infants with congenital pulmonary airway malformations after surgery: a short and mid-term evaluation. Am J Transl Res, 2024, 16(1): 208-215.
5.	Davenport M, Warne SA, Cacciaguerra S, et al. Current outcome of antenally diagnosed cystic lung disease. J Pediatr Surg, 2004, 39(4): 549-556.
6.	Bonnard A. Thoracoscopic lobectomy for congenital pulmonary airway malformation: where are we in 2019? Eur J Pediatr Surg, 2020, 30(2): 146-149.
7.	He T, Sun X, Liu C, et al. Learning curve for total thoracoscopic segmentectomy in treating pediatric patients with congenital lung malformation. Surg Endosc, 2023, 37(7): 5129-5136.
8.	Yuan M, Xu C, Luo D, et al. A novel surgical method for congenital lung malformations: a pilot study. Semin Thorac Cardiovasc Surg, 2023, 35(3): 541-547.
9.	Yuan M, Liu J, Wang Z, et al. A clinical comparative study of thoracoscopic anatomical lesion resection and lobectomy in the treatment of congenital lung malformations. J Pediatr Surg, 2024, 59(9): 1714-1718.
10.	He T, Sun X, Che G, et al. Thoracoscopic anatomical lesion resection by fluorescence imaging on congenital lung malformation. Asian J Surg, 2025, 48(4): 2298-2301.
11.	He T, Sun X, Che G, et al. Fluorescence imaging-assisted thoracoscopic anatomical lesion resection in treating congenital lung malformation. Sci Rep, 2025, 15(1): 755.
12.	Quan YH, Oh CH, Jung D, et al. Evaluation of intraoperative near-infrared fluorescence visualization of the lung tumor margin with indocyanine green inhalation. JAMA Surg, 2020, 155(8): 732-740.
13.	Nakajima C, Kijimoto C, Yokoyama Y, et al. Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth. Pediatr Surg Int, 1998, 13(5-6): 341-345.
14.	Dunn A, Pearce K, Callister R, et al. Exercise capacity is not decreased in children who have undergone lung resection early in life for congenital thoracic malformations compared to healthy age‐matched children. Pediatr Pulmonol, 2017, 52(10): 1340-1348.

1. Dehner LP, Schultz KAP, Hill DA. Congenital pulmonary airway malformations with a reconsideration and current perspective on the Stocker classification. Pediatr Dev Pathol, 2023, 26(3): 241-249.
2. 中華醫學會小兒外科學分會普胸外科學組, 中國醫療保健國際交流促進會婦兒醫療保健分會. 先天性肺氣道畸形診療中國專家共識(2021版). 中華小兒外科雜志, 2021, 42(8): 679-687.Section of General Thoracic Surgery, Branch of Pediatric Surgery, Chinese Medical Association; Branch of Women and Children's Medical Care, China International Exchange and Promotive Association for Medical and Health Care. National expert consensus on diagnosis & treatment of congenital pulmonary airway malformations in China (2021). Chin J Pediatr Surg, 2021, 42(8): 679-687.
3. Huang JX, Hong SM, Hong JJ, et al. Medium-term pulmonary function test after thoracoscopic lobectomy and segmentectomy for congenital lung malformation: a comparative study with normal control. Front Pediatr, 2021, 9: 755328.
4. Liao J, Lin M, Zeng J, et al. Prognosis of infants with congenital pulmonary airway malformations after surgery: a short and mid-term evaluation. Am J Transl Res, 2024, 16(1): 208-215.
5. Davenport M, Warne SA, Cacciaguerra S, et al. Current outcome of antenally diagnosed cystic lung disease. J Pediatr Surg, 2004, 39(4): 549-556.
6. Bonnard A. Thoracoscopic lobectomy for congenital pulmonary airway malformation: where are we in 2019? Eur J Pediatr Surg, 2020, 30(2): 146-149.
7. He T, Sun X, Liu C, et al. Learning curve for total thoracoscopic segmentectomy in treating pediatric patients with congenital lung malformation. Surg Endosc, 2023, 37(7): 5129-5136.
8. Yuan M, Xu C, Luo D, et al. A novel surgical method for congenital lung malformations: a pilot study. Semin Thorac Cardiovasc Surg, 2023, 35(3): 541-547.
9. Yuan M, Liu J, Wang Z, et al. A clinical comparative study of thoracoscopic anatomical lesion resection and lobectomy in the treatment of congenital lung malformations. J Pediatr Surg, 2024, 59(9): 1714-1718.
10. He T, Sun X, Che G, et al. Thoracoscopic anatomical lesion resection by fluorescence imaging on congenital lung malformation. Asian J Surg, 2025, 48(4): 2298-2301.
11. He T, Sun X, Che G, et al. Fluorescence imaging-assisted thoracoscopic anatomical lesion resection in treating congenital lung malformation. Sci Rep, 2025, 15(1): 755.
12. Quan YH, Oh CH, Jung D, et al. Evaluation of intraoperative near-infrared fluorescence visualization of the lung tumor margin with indocyanine green inhalation. JAMA Surg, 2020, 155(8): 732-740.
13. Nakajima C, Kijimoto C, Yokoyama Y, et al. Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth. Pediatr Surg Int, 1998, 13(5-6): 341-345.
14. Dunn A, Pearce K, Callister R, et al. Exercise capacity is not decreased in children who have undergone lung resection early in life for congenital thoracic malformations compared to healthy age‐matched children. Pediatr Pulmonol, 2017, 52(10): 1340-1348.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesPreoperative nebulized indocyanine green-assisted thoracoscopic anatomical lesion resection for congenital pulmonary airway malformations in children: A retrospective cohort study

Abstract Full text Figures/Tables Video References Cited by

Format

Content