Application of indocyanine green fluorescence imaging in video-assisted thoracoscopic surgery for esophageal carcinoma

Abstract

Objective To study the clinical use of indocyanine green(ICG) fluorescence imaging in video-assisted thoracoscopic surgery (VATS) for the treatment of esophageal carcinoma. Methods 32 cases with esophageal cancer were randomly selected as the experimental group. ICG fluorescence imaging technique was applied in this group to evaluate the blood perfusion of tubular stomach during thoracoscopic surgery, and to determine the well-perfused area for anastomosis. Clinical symptoms and imaging were used to diagnosis anastomotic leakage after esophagectomy. Another 38 patients with esophageal cancer with routine surgery were randomly selected as the control group. Results There were no deaths or other adverse reactions caused by indocyanine green ICG injection. The cervical esophagogastrostomy through the esophageal bed was performed in all patients, with stapled anastomoses in 52 cases (experimental group 24, control group28), and manual anastomosis in 18 cases (experimental group 8, control group 10). There was no statistical difference in the methods of anastomosis between the two groups(P>0.05). Clinical symptoms and imaging confirmed 7 cases of anastomotic leakage, with 2 cases in experimental group (6.25%) and 5 cases in the control group(13.15%). The incidence of anastomotic leakage in the experiment group was significantly lower than that in the control group. Conclusions ICG fluorescence imaging is a safe and effective technology to evaluate blood perfusion of tubular stomach in a visualized way during surgery and to reduce anastomotic leakage after esophagectomy. Key words: Indocyanine green; Fluorescence imaging; Video-assisted thoracoscopic surgery; Esophageal carcinoma