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.

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 Minimally invasive esophagectomy: Preservation of arch of Azygos vein in prone position

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Madhabananda Kar ◽  
Mohammed Imaduddin ◽  
DillipK Muduly ◽  
Mahesh Sultania ◽  
Tim Houghton ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Azygos Vein ◽  
Invasive Esophagectomy

Intraoperative Lipid-Rich Nutrition in the Detection of Chylothorax in Minimally Invasive Ivor Lewis Esophagectomy

2019 ◽  
Vol 26 (5) ◽  
pp. 545-550
Author(s):  
Merel Lubbers ◽  
Marc J. van Det ◽  
Ewout A. Kouwenhoven
Keyword(s):  
Minimally Invasive ◽  
Thoracic Duct ◽  
Minimally Invasive Esophagectomy ◽  
Control Group ◽  
Historical Cohort ◽  
Feeding Jejunostomy ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Rich Solution ◽  
Group A

Background. Chylothorax is a rare but severe complication after esophagectomy with an incidence of 1.9% to 8.9%. The aim of this study was to evaluate the efficacy of intraoperative lipid-rich feeding in reducing the incidence of post-esophagectomy chylothorax. Methods. A retrospective cohort study was performed among patients who underwent totally minimally invasive esophagectomy with intrathoracic anastomosis (tMIE Ivor Lewis) from February 2015 until December 2016. In this group, a lipid-rich solution was administered intraoperatively via a feeding jejunostomy. A historical cohort of identical patients operated in the period December 2012 to February 2015 did not receive intraoperative feeding and was used as a control. Results. In total, 133 patients underwent tMIE Ivor Lewis, of whom 59 patients (44%) received lipid-rich solution intraoperatively. The administered median total volume was 800 mL. During thoracic dissection, the thoracic duct was clearly visible in 37 patients (63%). With the help of lipid-rich feeding, intraoperative unintended duct damage was detected in 3 patients and treated. Postoperatively, 1 out of 59 patients (1.7%) developed chylothorax that was managed nonoperatively. In the control group, chylothorax was seen in 3 out of 74 patients (4.1%), P = .629. Conclusions. Intraoperative lipid-rich solution through a feeding jejunostomy helps identify thoracic duct damage during tMIE and may reduce postoperative chylothorax.

scholarly journals Minimally invasive esophagectomy in the lateral-prone position: Experience of 124 cases in a single center

2017 ◽  
Vol 9 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Shaohua Ma ◽  
Tianshen Yan ◽  
Dandan Liu ◽  
Keyi Wang ◽  
Jingdi Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Single Center ◽  
Invasive Esophagectomy

Technical and perioperative outcomes of minimally invasive esophagectomy in the prone position

2012 ◽  
Vol 27 (2) ◽  
pp. 553-557 ◽  
Author(s):  
Ross F. Goldberg ◽  
Steven P. Bowers ◽  
Michael Parker ◽  
John A. Stauffer ◽  
Horacio J. Asbun ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Perioperative Outcomes ◽  
Invasive Esophagectomy
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