Novel Uses of Indocyanine Green in Thoracic Surgery: A Review and Case Series

Indocyanine green (ICG) is a water-soluble molecule that emits fluorescence in the near-infrared light spectrum. Due to its fluorescence properties, safety profile, and cost-effectiveness, ICG is used in minimally invasive surgery, enabling real-time visualization of structures during the operation. Until recently, its use was mainly limited to robotic surgery, which required specific technological setups to visualize the fluorescence. With recent technological advancements, however, similar capabilities can now be integrated into smaller laparoscopic instruments, broadening the accessibility and usefulness of ICG. In this article, we present various innovative applications of ICG in thoracic surgery, drawing from recent developments in the field and our own experiences. Specifically, we focus on the novel role of ICG in the evaluation of gastric conduit perfusion, lung nodule localization, and thoracic duct ligation.