Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung

Objective: We have previously reported that infrared thoracoscopy was useful in detecting emphysematous lesions in a canine model of lung emphysema. We applied infrared thoracoscopy to determine the feasibility and efficacy of planning bullectomy for patients with spontaneous pneumothorax. Methods: A total of 8 patients with spontaneous pneumothorax were included in the study. No procedure-related complications were observed. Infrared thoracoscopy with a single injection of indocyanine green (3.0 mg/kg) was used to detect bullous lesions of the lung, during surgical intervention. Partial lung resections of the bullous lesions were performed after image analysis based on color density data obtained by means of infrared thoracoscopy. Results: Bullous or emphysematous lesions of the lung were demonstrated in white, whereas normal lung tissue was imaged in blue, under infrared thoracoscopy. We were able to detect small bullous lesions with infrared thoracoscopy because of its clearer visualization compared with thoracoscopy. Quantitative color-density analysis revealed a marked decrease of indocyanine green intensity, which reflected decreased blood flow of bullous lesions. All resected specimens were confirmed as bullous lesions based on microscopic examinations. Conclusion: Infrared thoracoscopy-guided lung resection is a safe and useful procedure in detecting small bullous lesions.