#269 Indocyanine Green Fluorescence Guided Robot Assisted Transthoracic Oesophagectomy- Dr.K Agrawal

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Abstract: INDOCYANINE GREEN FLOURESCENCE GUIDED ROBOTIC ASSISTED TRANSTHORACIC OESOPHAGECTOMY

INTRODUCTION- INDOCYANINE GREEN DYE HAS MULTIPLE USE IN SURGICAL PRATICE. HERE WE DEMONSTRATE THE USE OF ICG FLOURESCENCE DURING ROBOTIC ASSISTED TRANTHORACIC OESOPHAGECTOMY AND HOW THIS TECHNOLOGY CAN HELP US PREVENT THE DREADED COMPLICATION OF CHYLOTHORAX AND GASTRIC CONDUIT NECROSIS.

OBJECTIVE– TO DEMONSTRATE DETAILED SURGICAL PROCEDURE OF ROBOTIC ASSISTED TRANSTHORACIC OESOPHAGECTOMY WITH 2 FIELD LYMPHADENECTOMY AND TO EVALUATE THE ROLE OF ICG-NIR FLOURESCENCE IMAGING IN REAL TIME IDENTIFICATION OF THORACIC DUCT DURING THE SURGERY AND ALSO TO ASSESS GASTRIC CONDUIT VIABILITY

METHOD– DOSE OF ICG DYE USED IS 2.5MG/ML. SITE OF INJECTION FOR THORACIC DUCT IDENTIFICATION IS EITHER 1ST WEB SPACE OF BILATERAL LOWER LIMB OR SUPERFICIAL INGUINAL LYMPH NODE USING USG GUIDANCE. IN BOTH SCENARIO, 1 ML OF DYE IN INJECTED BILATERALLY, JUST AFTER GENERAL ANAESTHESIA. FOR GASTRIC CONDUIT VIABLITY 3ML OF DYE IS INJECTED INTRAVENOUSLY JUST BEFORE OESPHAGO-GASTRIC ANASTOMOSIS. THE SYSTEM USED FOR THE PROCEDURE IS DAVINCI X WITH INBUILT FIREFLY TECHNOLOGY

RESULT– IN OUR SERIES OF 168 PTS, ANASTOMOTIC LEAK RATES WERE 2.9%, WHILE CHYLE LEAK RATES WERE 1.8%. ICG FLOURESCENCE WAS DETECTED IN 100% CASES WHEN INJECTED IN SUPERFICIAL INGUINAL LYMPH NODE WHILE IT WAS AROUND 70% WHEN INJECTED IN 1ST WEB SPACE.

CONCLUSION– USE OF ICG IS AN EASY AND SAFE METHOD FOR REAL TIME IDENTIFICATION AND PRESERVATION OF THORACIC DUCT DURING TRANTHORACIC ESOPHAGECTOMY. IT ALSO HELPS IN ASSESSING GASTRIC CONDUIT VASCULARITY AND AVOID ANASTOMOTIC LEAKS.

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