Abstract
Accurate localisation of small or non-palpable pulmonary lesions is critical for successful minimally invasive resection. Indocyanine green (ICG)-soaked embolisation coil placement is an emerging fluorescence-guided marking method, typically applied to subpleural nodules. We present a four-patient case series-the first in Germany-where ICG-soaked embolisation coils were placed using ultrathin bronchoscopy, a standard cytology brush catheter and cone beam CT (CBCT) guidance, without robotic bronchoscopy. Lesions were confirmed with radial endobronchial ultrasound (EBUS), and resection was performed via uniportal video-assisted thoracoscopic surgery (VATS). Marking was successful in all cases without complications. One patient underwent dual-coil placement to enable three-dimensional bracketing of a non-subpleural lesion, facilitating precise anatomical resection. Histologies included squamous cell carcinoma (n = 1), adenocarcinoma (n = 1), hamartoma (n = 1) and typical carcinoid (n = 1). All patients achieved R0 resections. ICG-soaked coil placement via ultrathin bronchoscopy is a safe, reproducible and effective localisation technique, even in centres without robotic navigation systems. This series demonstrates feasibility across diverse lesion locations and expands the applicability of fluorescence-guided thoracic surgery to more centrally oriented nodules.