Abstract
Recognition and repair of thoracic duct and it’s injury make the management of chyle leak difficult. Traditional methods like lymphoscintigraphy, lymphangiography and preoperative oral cream ingestion to identify the thoracic duct find limited use in intraoperative identification with poor contrast and precision. Near-infrared (NIR) fluorescence by indocyanine green dye (ICG) provides a feasible, real-time imaging of thoracic ductal anatomy during thoracoscopic surgery, thereby potentially reducing injury of thoracic duct.
Methods
We describe successful identification of the thoracic duct in real-time during minimally invasive esophagectomy by Indocyanine green (ICG) lymphangiography in a series of 10 patients with carcinoma esophagus post chemoradiotherapy. Intraoperative fluorescence lymphangiography was performed by injecting 2.5 to 7.5 mg of ICG. into small bowel mesentery in 5, groin in 2 and both mesentery and groin in 3.
Results
Time required for appearance of ICG fluorescence in thoracic duct ranged from 60 to 120 min. Thoracic duct was successfully identified and delineated in 8 cases, and not detected in 2 cases. There were no chyle leaks in the postoperative period, and all the patients were discharged uneventfully.
Conclusion
ICG fluorescence lymphangiography provides a feasible, reliable, and real-time imaging of thoracic duct during esophagectomy, thereby potentially reducing the thoracic duct injuries. In this series the non detection of thoracic duct in cases and the appearance of fluorescence at varied interval of time might be due to erratic expression of ICG fluorescence owing to extensive fibrosis in thorax secondarily to chemoradiation. This study should serve as a bench mark for larger studies in future.
Real time cholangiography using indocyanine green near-infrared fluorescence imaging in living donor hepatectomy
