Specific Findings of Blood Perfusion on Anastomosed Esophagus of Neonatal Esophageal Atresia and Tracheoesophageal Fistula Using Indocyanine Green Fluorescence During Thoracoscopic Surgery

We herein report a neonatal case showing specific findings of blood perfusion in the anastomosed esophagus of esophageal atresia (EA) and tracheoesophageal fistula (TEF) using indocyanine green (ICG) fluorescence during thoracoscopic surgery. The patient was a 3054 g, 0-day neonatal boy diagnosed with EA-TEF based on a coil-up sign of the nasogastric tube. Thoracoscopic surgery was performed on Day 4 after birth. After TEF transection, esophageal anastomosis was performed using interrupted sutures. ICG was administered intravenously to confirm blood perfusion at the anastomotic site. Initially, the upper esophagus was visualized, and 5 s later, the lower esophagus was visualized. However, no fluorescence signal was detected at the anastomotic site. The postoperative course was uneventful without anastomotic leakage. After discharge, mild anastomotic stenosis was observed, which required balloon dilatation. The time lag of fluorescent findings was considered to reflect differences in the feeding artery.