Robotic Surgery for Pulmonary Sequestration: Indocyanine Green as a Key Tool for Precision

Pulmonary sequestration is a rare congenital lung malformation characterized by non-functioning lung tissue with a systemic arterial supply, usually from the aorta. Surgical removal is indicated to prevent infection, bleeding, and other complications. 

This video presents the case of a 39-year-old patient with intralobar pulmonary sequestration in the right lower lobe, identified by imaging showing an aberrant artery from the abdominal aorta supplying the abnormal lung segment. A robotic-assisted approach was chosen for its precision and enhanced visualization. 
 
The surgery began with identification and dissection of the abnormal artery, which was carefully ligated using a stapler despite its difficult location near the spine. A key step involved the intravenous injection of indocyanine green (ICG) dye, which fluoresces under near-infrared light, allowing clear distinction between normally perfused lung and the sequestrated segment that remained dark. 
 
Using ICG fluorescence, the surgical margins were accurately marked to guide an atypical segmentectomy, ensuring complete resection of the diseased tissue while preserving healthy lung. 
 
Postoperative recovery was smooth, with the patient discharged on the first day after surgery. Pathology confirmed intralobar pulmonary sequestration. 
 
This case highlights the advantages of combining robotic technology with real-time ICG imaging, which enhances the surgeon’s ability to precisely identify and resect abnormal lung segments, improving surgical outcomes and patient safety. 

References

1. Matsuoka, S., Eguchi, T., Takeda, T. et al. Three-dimensional computed tomography and indocyanine green-guided technique for pulmonary sequestration surgery. Gen Thorac Cardiovasc Surg 69, 621–624 (2021). https://doi.org/10.1007/s11748-020-01511-2
2. Mohnke J, et al. Intralobar pulmonary sequestration: robotical resection using indocyanine green. J Surg Case Rep 2023 Mar 3;2023(3):rjad028. doi: 10.1093/jscr/rjad028
3. Nakanishi K, et al. Complete visualization using indocyanine green in thoracic surgery for pulmonary sequestration. J Thorac Dis 2023;15(10):5714-5722 | https://dx.doi.org/10.21037/jtd-23-892

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.