Use of indocyanine green for the reconstruction with Roux-en-Y after minimally invasive esophagectomy

2021 ◽  
Author(s):  
Andrés Navarrete ◽  
Roberto Humeres
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy

scholarly journals Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position

2020 ◽  
Vol 33 (12) ◽  
Author(s):  
Massimo Vecchiato ◽  
Antonio Martino ◽  
Massimo Sponza ◽  
Alessandro Uzzau ◽  
Antonio Ziccarelli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Prone Position ◽  
Thoracic Duct ◽  
Minimally Invasive Esophagectomy ◽  
Standard Procedure ◽  
Transthoracic Esophagectomy ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Invasive Esophagectomy

Abstract Chylothorax is a serious complication of transthoracic esophagectomy. Intraoperative thoracic duct (TD) identification represents a possible tool for preventing or repairing its lesions, and it is most of the time difficult, even during high-definition thoracoscopy. The aim of the study is to demonstrate the feasibility of using near-infrared fluorescence-guided thoracoscopy to identify TD anatomy and check its intraoperative lesions during minimally invasive esophagectomy. A 0.5 mg/kg solution of indocyanine green (ICG) was injected percutaneously in the inguinal nodes of 19 patients undergoing minimally invasive esophagectomy in a prone position, before thoracoscopy. TD anatomy and potential intraoperative lesions were checked with the KARL STORZ OPAL1® Technology. In all of the 19 patients where transthoracic esophagectomy was feasible, the TD was clearly identified after a mean of 52.7 minutes from injection time. The TD was cut for oncological radicality in two patients, and it was successfully ligated under the ICG guide. No postoperative chylothorax or adverse reactions from the ICG injection occurred. The TD identification with indocyanine green fluorescence during minimally invasive esophagectomy is a simple, effective, and non-time-demanding tool; it may become a standard procedure to prevent postoperative chylothorax.

Use of Indocyanine Green (ICG) Fluorescence in Minimally Invasive Esophagectomy to Assess Conduit Vascularity

2017 ◽  
Vol 152 (5) ◽  
pp. S1243 ◽  
Author(s):  
Ian Yu Hong Wong ◽  
Siu Y. Chan ◽  
Daniel King Hung Tong ◽  
Kwan Kit Chan ◽  
Claudia Wong ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy

scholarly journals Intraoperative Near-Infrared Fluorescence Imaging as an Adjunct to Robotic-Assisted Minimally Invasive Esophagectomy

2014 ◽  
Vol 9 (5) ◽  
pp. 391-393 ◽  
Author(s):  
Inderpal S. Sarkaria ◽  
Manjit S. Bains ◽  
David J. Finley ◽  
Prasad S. Adusumilli ◽  
James Huang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Minimally Invasive Esophagectomy ◽  
Near Infrared Fluorescence ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Vascular Arcade ◽  
Near Infrared Fluorescence Imaging

During esophagectomy, identification and preservation of the right gastroepiploic vascular arcade are critical and may be challenging with minimally invasive approaches. We assessed the use of near-infrared fluorescence imaging fluorescence angiography (NIFI-FA) during robotic-assisted minimally invasive esophagectomy (RAMIE) as an aid to visualize the gastric vasculature with mobilization. After intravenous administration of 10 mg of indocyanine green, a robotic platform with near-infrared optical fluorescence capability was used to examine the gastric vasculature in patients undergoing RAMIE. Thirty (71%) of 42 patients undergoing RAMIE were assessed using NIFI-FA during mobilization of the greater gastric curve and fundus; 11 were excluded because the system was not available, and 1 was excluded because of documented allergy to iodinated contrast. The median time from indocyanine green administration to detectable fluorescence was 37.5 seconds (range, 20–105 seconds). Near-infrared fluorescence imaging FA identified or confirmed termination of the vascular arcade in all 30 cases. Subjectively, NIFI-FA often identified otherwise unvisualized small transverse vessels between the termination of the vascular arcade and the first short gastric artery, as well as between the short gastric arteries. Identification and/or confirmation of the vascular arcade position during mobilization of the greater curve/omentum were also aided by NIFI-FA. Although there are limitations to the current technology, NIFI-FA may be a useful adjunct to confirm and identify the position of gastroepiploic vessels, allow for safer and more confident dissections during gastric mobilization, as well as potentially decrease serious intraoperative vascular misadventures.

scholarly journals Efficacy of Indocyanine Green Fluorescence Angiography in Preventing Anastomotic Leakage After McKeown Minimally Invasive Esophagectomy

2021 ◽  
Vol 10 ◽  
Author(s):  
Rao-Jun Luo ◽  
Zi-Yi Zhu ◽  
Zheng-Fu He ◽  
Yong Xu ◽  
Yun-Zheng Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Fluorescence Angiography ◽  
Perioperative Outcomes ◽  
Vascular Perfusion ◽  
Indocyanine Green Fluorescence ◽  
Invasive Esophagectomy ◽  
Patient Demographics

BackgroundIndocyanine green (ICG) fluorescence angiography (FA) was introduced to provide real-time intraoperative evaluation of the vascular perfusion of the gastric conduit during esophagectomy. However, its efficacy has not yet been proven. The aim of this study was to assess the usefulness of ICG-FA in the reduction of the rates of anastomotic leakage (AL) in McKeown minimally invasive esophagectomy (MIE).MethodsFrom June 2017 to December 2019, patients aged between 18 and 80 years with esophageal carcinoma were enrolled in the study and each patient underwent McKeown MIE. Patients were divided into two groups, those with or without ICG-FA. The patient demographics and perioperative outcomes were comparable between the two groups. The primary outcome was the rate of AL.ResultsA total of 192 patients were included: 86 in the ICG-FA group and 106 in the non-ICG-FA group. Overall, 12 patients (6.3%) had AL; the rate of AL was 10.4% in the non-ICG-FA group, which was significantly higher than the 1.2% in the ICG-FA group.ConclusionsICG-FA has the potential to reduce the rate of AL in McKeown MIE.

RA01.06: TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY IN A PATIENT WITH PREVIOUS NISSEN FUNDOPLICATION: CAN INDOCYANINE GREEN BE A USEFUL TOOL?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Victor Turrado-Rodriguez ◽  
Dulce Nombre De Maria Momblan ◽  
Alba Torroella ◽  
Ainitze Ibarzabal ◽  
Yoelimar Carolina Guzman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Prone Position ◽  
Nissen Fundoplication ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Hiatal Hernia Repair ◽  
Nerve Paralysis ◽  
Invasive Esophagectomy

Abstract Description Total esophagectomy may be technically demanding. Previous abdominal surgeries may increase the difficulty of the technique, especially when affecting the stomach as a gastric conduit is the preferred method for reconstruction. In this video, we demonstrate that the creation of the gastric conduit is feasible even with a previous Nissen fundoplication and that the use of indocyanine green (ICG) is useful to assess the vascularization of the gastric conduit. Methods A 70-year-old woman with medical history of high blood pressure, hysterectomy and hiatal hernia repair with laparoscopic Nissen fundoplication presented with symptoms of dysphagia and weight loss and was diagnosed of an adenocarcinoma of the esophagus (25 to 32 cm from the incisives) cT3N1. Neoadjuvant chemo-radiotherapy following CROSS scheme was administered. A total minimally invasive esophagectomy was performed in the prone position for the thoracic time. Concerns about the length of the gastric conduit due to the fundoplication were present during surgery. ICG was used to locate the right gastroepiploic arcade, asses the vascularization of the gastric conduit, specially in the gastric fundus, and after cervicotomy, to assess the vascularization of the gastric stump before performing the anastomosis. Results Surgical time was 360 minutes. Postoperative evolution was satisfactory except for hoarseness due to a possible right recurrent laryngeal nerve paralysis. She was discharged on the 11th postoperative day. Pathology confirmed an adenocarcinoma of the mid esophagus ypT1bN1 (1/15). Conclusions Totally minimally invasive esophagectomy in the prone position is feasible even in the case of previous upper gastrointestinal surgeries, such as Nissen fundoplication. The use of ICG is useful for the identification of the gastroepiploic arcade, assessment of the vascular supply to the gastric conduit and to the anastomosis, especially when a McKeown esophagectomy is performed. Disclosure All authors have declared no conflicts of interest.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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