Near-infrared intraoperative fluorescence imaging using indocyanine green in thoracic duct ligation surgery in patients with chylothorax

Surgery is an effective treatment for chylothorax, particularly in cases of high-output chylothorax. However, precisely locating the thoracic duct for ligation and observing the surgical outcomes intraoperatively remains a challenge for surgeons. In this study, we demonstrated the feasibility of using Near-infrared (NIR) fluorescence imaging for thoracic duct ligation following indocyanine green (ICG) injection. Five patients with chylothorax who underwent surgery at our center were retrospectively included in this study. Of these, two had postoperative chylothorax following esophageal cancer surgery, one had postoperative chylothorax following lung cancer surgery, and two had spontaneous chylothorax. All patients received inguinal lymph node injections of ICG and subsequently underwent thoracic duct ligation under NIR-guided video-assisted thoracoscopic surgery (VATS) after anesthesia. All patients underwent NIR-guided ICG injection followed by VATS thoracic duct ligation. Four patients were operated on via the right side and one via the left side. The mean operative time was 62 min, the mean SBR value was 4.19, the mean postoperative drainage was 229.6 ml/day, the mean duration of postoperative chest drainage was 6.2 days, and the mean hospital stay was 17.8 days. None of the patients experienced recurrence of chylothorax postoperatively or during follow-up. In conclusion, NIR combined with ICG injection is highly effective in exploring and exposing the thoracic duct, as well as in determining the surgical outcome of thoracic duct ligation in real time.