Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Thoracic Duct Identification With Indocyanine Green Fluorescence to Prevent Chyle Leaks During Minimally Invasive Esophagectomy Publisher Pubmed



Mahmoodzadeh H1 ; Farahzadi A1 ; Omranipour R1 ; Harirchi I1 ; Jalaeefar A1 ; Shirkhoda M1 ; Miri SR1 ; Hadjilooei F2
Authors
Show Affiliations
Authors Affiliations
  1. 1. Department of General Surgery, Tehran University of Medical Sciences, Cancer Institute, Tehran, Iran
  2. 2. Tehran University of Medical Sciences, Cancer Institute, Tehran, Iran

Source: Cancer Reports Published:2024


Abstract

Introduction: Chylothorax (CT) is a rare yet serious complication after esophagectomy. Identification of the thoracic duct (TD) during esophagectomy is challenging due to its anatomical variation. Real-time identification of TD may help to prevent its injury. Near infra-red imaging with Indocyanine green (ICG) is a novel technique that recently has been used to overcome this issue. Methods: Patients who underwent minimally invasive esophagectomy for esophageal cancer were divided into two groups with and without ICG. We injected ICG into bilateral superficial inguinal lymph nodes. Identification of TD and its injuries during the operation was evaluated and compared with the non-ICG group. Results: Eighteen patients received ICG, and 18 patients underwent surgery without ICG. Each group had one (5.5%) TD ligation. In the ICG group injury was detected intraoperative, and ligation was done at the site of injury. In all cases, the entire thoracic course of TD was visualized intraoperatively after a mean time of 81.39 min from ICG injection to visualization. The Mean extra time for ICG injection was 11.94 min. In the ICG group, no patient suffered from CT. One patient in the non-ICG group developed CT after surgery that was managed conservatively. According to Fisher's exact test, there was no significant association between CT development and ICG use, possibly due to the small sample size. Conclusions: This study confirms that ICG administration into bilateral superficial inguinal lymph nodes can highlight the TD and reduce its damage during esophagectomy. It can be a standard method for the prevention of postoperative CT. © 2024 The Authors. Cancer Reports published by Wiley Periodicals LLC.