ObjectiveTo investigate the efficacy of preoperative nebulized indocyanine green (ICG)-assisted thoracoscopic anatomical lesion resection (TALR) in treating pediatric congenital pulmonary airway malformation (CPAM). MethodsA 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. ResultsA 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). ConclusionPreoperative nebulized ICG administration facilitates lesion identification in CPAM, reduces technical difficulty of TALR, enhances therapeutic outcomes, and provides valuable assistance for performing TALR procedures.