Application of Indocyanine Green Enhanced Fluorescence in Esophageal Surgery: A Mini Review

Abstract

Despite recent technological innovations and the development of minimally invasive surgery, esophagectomy remains an operation burdened with severe postoperative complications. Fluorescence imaging, particularly using indocyanine green (ICG), offers the ability to address a number of issues faced during esophagectomy. The three main indications for the intraoperative use of ICG during esophagectomy are visualization of conduit vascular supply, allow identification of sentinel nodes and visualization of the thoracic duct. The purpose of this mini review is to present an overview of current practice in fluorescence imaging utilizing ICG during esophagectomy, as well as to demonstrate how this technology can guide lymphadenectomy and reduce surgical morbidity such as anastomotic leaking and chylothorax.

Keywords: anastomotic leak; chylothorax; esophaeal cancer; fluorescence imaging; indocianin green; indocianine green angiography; sentinel node; surgery.

Figure 1

A dose 0.5 mg/kg of ICG is injected percutaneously bilaterally in the superficial inguinal nodes under ultrasound visualization. This procedure is performed before thoracoscopy in total esophagectomy, or after laparoscopic time in Ivor Lewis esophagectomy.

Figure 2

Intraoperative NIR imaging of thoracic duct in a patient with diagnosed distal oesophageal cancer. The procedure allowed surgeons to identify the thoracic duct during surgery.