Thoracic duct identification with indocyanine green fluorescence: a simplified method

Abstract

We read with interest the article by Vecchiato et al. ‘Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with the patient in a prone position’. recently published in Dis Esophagus.1 The authors described a method to visualize the thoracic duct (TD) during esophagectomy by performing an ultrasound-guided (US) injection of indocyanine green (ICG) in the inguinal nodes. Chylothorax is a rare but serious complication in esophageal surgery. It delays oral intake, increases hospital stay, and negatively affects overall survival.2,3 Preventive measures aimed at decreasing the incidence of TD injuries could potentially reduce the postoperative morbidity associated with this complication. In our experience, the use of ICG US-guided inguinal node injection to identify TD during robotic esophagectomy using Firefly® system is safe and reproducible but the US-guided procedure could be complex, requires trained staff, and extends operating times. Recently we revised the procedure...