Summary: One method to improve visualization of the thoracic duct (TD) during surgery is to improve its identification through the application of indocyanine green (ICG). The primary objective of this study was to verify whether the application of indocyanine green via parenteral injection improved visualization of the TD during minimally invasive esophagectomy (MIE) with patients in the prone position. This is the first study authorized by the Italian Medicines Agency (AIFA) with Eudra CT 2019–004374-25. In this study, 0.5 mg/kg of ICG reconstituted in 10 mL of water for injection was injected percutaneously into the germinal center of bilateral superficial inguinal lymph nodes in each patient prior to thoracoscopy in total and subtotal esophagectomy. KARL STORZ OPAL1® technology was used for NIR imaging with ICG. The TD was clearly identified in all fifty-two patients in whom transthoracic esophagectomy was feasible. No adverse reactions to the ICG injection occurred. We had one postoperative chylothorax. NIR-ICG imaging during minimally invasive esophagectomy is highly effective in identifying the thoracic duct. Given the number of cases and the visualization rate, we conclude that the procedure could be used in esophageal surgery and could significantly reduce the rate of postoperative chylothorax.
VERDEDT 1.0: five years single-center experience with real-time indocyanine green fluorescence imaging of the thoracic duct during minimally invasive esophagectomy
Uzzau A.;
2026-01-01
Abstract
Summary: One method to improve visualization of the thoracic duct (TD) during surgery is to improve its identification through the application of indocyanine green (ICG). The primary objective of this study was to verify whether the application of indocyanine green via parenteral injection improved visualization of the TD during minimally invasive esophagectomy (MIE) with patients in the prone position. This is the first study authorized by the Italian Medicines Agency (AIFA) with Eudra CT 2019–004374-25. In this study, 0.5 mg/kg of ICG reconstituted in 10 mL of water for injection was injected percutaneously into the germinal center of bilateral superficial inguinal lymph nodes in each patient prior to thoracoscopy in total and subtotal esophagectomy. KARL STORZ OPAL1® technology was used for NIR imaging with ICG. The TD was clearly identified in all fifty-two patients in whom transthoracic esophagectomy was feasible. No adverse reactions to the ICG injection occurred. We had one postoperative chylothorax. NIR-ICG imaging during minimally invasive esophagectomy is highly effective in identifying the thoracic duct. Given the number of cases and the visualization rate, we conclude that the procedure could be used in esophageal surgery and could significantly reduce the rate of postoperative chylothorax.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
