Dual Indocyanine Green (ICG)-Soaked Coil Placement for the Precise Localization of a Non-subpleural Peripheral Lung Nodule: A Modified Technique in a Case Report

Accurate localization of small pulmonary nodules is essential for successful minimally invasive resection. Conventional preoperative localization techniques, such as placement of indocyanine green (ICG)-soaked coils, are optimized for nodules in close proximity to the pleura. We report on a novel dual-coil approach in a 45-year-old non-smoking patient with a PET-avid lesion, incidentally discovered during a trauma workup. The 9 mm right upper lobe lesion was located peripherally but not subpleural, with partial endobronchial and central orientation. Using flexible bronchoscopy, two ICG-soaked embolization coils were deployed: one distally within the segment to mark the boundary, and one proximally, just adjacent to the lesion. This approach enabled the three-dimensional bracketing of the nodule, allowing for precise anatomical resection via uniportal video-assisted thoracoscopic surgery (VATS) without the need for thoracotomy. This technique shows promise in expanding the utility of fluorescence-guided thoracoscopic resection by allowing localization of small, centrally oriented peripheral lung nodules that are not amenable to traditional single-coil marking.