Feng Yang1, Jian Zhou1, Hao Li1, Fan Yang1, Rongxin Xiao1, Chongwei Chi2, Jie Tian2, Jun Wang1. 1. Department of Thoracic Surgery, Center for Thoracic Mini-invasive Surgery, Peking University, People's Hospital, Beijing, China. 2. Key Laboratory of Molecular Imaging of the Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
Abstract
OBJECTIVES: Chylothorax is an infrequent but relatively serious complication after lung cancer surgery. Finding the leakage site and identifying the thoracic duct (TD) are the key points of surgical intervention for chylothorax. In this study, for the first time, we demonstrated near-infrared fluorescence imaging with indocyanine green (ICG) in video-assisted thoracoscopic surgery (VATS) intervention for chylothorax in humans. METHODS: This study included 4 patients diagnosed with chylothorax after lung cancer surgery who underwent VATS intervention; 0.2 mg/kg of ICG was injected subcutaneously into the bilateral inguinal region approximately 30 min before surgery. The D-light P® near-infrared thoracoscope was used for intraoperative fluorescence imaging. RESULTS: All patients underwent VATS intervention on the right side. Chyle leakage points were detected at the point of dissection of the station of the 4R lymph node behind the azygos vein in 3 patients and at the adjacent point of prophylactic ligation of the TD in 1 patient. The fluorescent hotspot of ICG leakage was detected first. The signal-to-background ratio of the TD or chyle averaged 4.41 (range 2.31-6.72). The TD fluorescent signals lasted for at least 1 h. With the guidance of real-time fluorescence lymphography, the fistulas and the main trunk of the TD were identified and double ligated. Small branches of the TD were occasionally detected and ligated. Chylothorax was managed successfully by surgical interventions in all patients. CONCLUSIONS: Near-infrared fluorescence imaging with ICG provided highly sensitive and real-time imaging of the TD in VATS intervention for chylothorax in humans. Clinical registration number: NCT02611245.
OBJECTIVES: Chylothorax is an infrequent but relatively serious complication after lung cancer surgery. Finding the leakage site and identifying the thoracic duct (TD) are the key points of surgical intervention for chylothorax. In this study, for the first time, we demonstrated near-infrared fluorescence imaging with indocyanine green (ICG) in video-assisted thoracoscopic surgery (VATS) intervention for chylothorax in humans. METHODS: This study included 4 patients diagnosed with chylothorax after lung cancer surgery who underwent VATS intervention; 0.2 mg/kg of ICG was injected subcutaneously into the bilateral inguinal region approximately 30 min before surgery. The D-light P® near-infrared thoracoscope was used for intraoperative fluorescence imaging. RESULTS: All patients underwent VATS intervention on the right side. Chyle leakage points were detected at the point of dissection of the station of the 4R lymph node behind the azygos vein in 3 patients and at the adjacent point of prophylactic ligation of the TD in 1 patient. The fluorescent hotspot of ICG leakage was detected first. The signal-to-background ratio of the TD or chyle averaged 4.41 (range 2.31-6.72). The TD fluorescent signals lasted for at least 1 h. With the guidance of real-time fluorescence lymphography, the fistulas and the main trunk of the TD were identified and double ligated. Small branches of the TD were occasionally detected and ligated. Chylothorax was managed successfully by surgical interventions in all patients. CONCLUSIONS: Near-infrared fluorescence imaging with ICG provided highly sensitive and real-time imaging of the TD in VATS intervention for chylothorax in humans. Clinical registration number: NCT02611245.
Authors: Francesco Londero; William Grossi; Massimo Vecchiato; Antonio Martino; Antonio Ziccarelli; Roberto Petri; Angelo Morelli Journal: Front Surg Date: 2022-05-04