# Tumour Localisation With ICG‐Soaked Embolisation Coils Without Robotic Bronchoscopy: First German Experience

## TL;DR

This paper describes a new technique for marking small lung tumors using ICG-soaked coils, successfully tested in four patients in Germany without robotic tools.

## Contribution

The first German case series demonstrating ICG-soaked coil placement for tumor localization without robotic bronchoscopy.

## Key findings

- ICG-soaked coils were successfully placed in all four patients using ultrathin bronchoscopy and CBCT guidance.
- The technique enabled R0 resections for diverse lesion types, including centrally located nodules.
- No complications were observed, showing the method is safe and effective in non-robotic settings.

## 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.

Accurate localisation of small or non‐palpable pulmonary lesions is critical for successful minimally invasive resection. 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.