The Role of Intraoperative Fluorescence Imaging During Esophagectomy

Published on Nov 1, 2018in Thoracic Surgery Clinics1.763
· DOI :10.1016/J.THORSURG.2018.07.009
Simon R. Turner6
Estimated H-index: 6
(U of A: University of Alberta),
Daniela R. Molena1
Estimated H-index: 1
(MSK: Memorial Sloan Kettering Cancer Center),
Daniela Molena25
Estimated H-index: 25
: Intraoperative fluorescence imaging (FI) with indocyanine green has several potential uses during esophagectomy. Intravascular injection for enhancing the visualization of conduit vascularity and assessing macro and microperfusion has the most literature support and may help reduce anastomotic leaks. Peritumoral injection has been reported for use in identifying sentinel nodes during lymphadenectomy and intralymphatic injection may be used to help preserve or ligate the thoracic duct. The authors' own technique of FI for conduit assessment is described. They routinely use this strategy to guide anastomosis placement and reduce leaks.
  • References (22)
  • Citations (3)
#1SchlottmannFrancisco (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 1
#2BarbettaArianna (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 1
Last. MolenaDaniela (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 1
view all 5 authors...
Abstract Objective: Nodal status is one of the most important long-term prognostic factors for esophageal cancer. The aim of this study was to evaluate the ability of near-infrared (NIR) light fluorescent imaging to identify the lymphatic drainage pattern of esophageal cancer. Methods: Patients with distal esophageal cancer or esophagogastric junction cancer scheduled for esophagectomy were enrolled in this study. Before surgery, an endoscopy was performed with submucosal injection of 2 cc of in...
13 CitationsSource
2 CitationsSource
#1Krista J. Hachey (Brigham and Women's Hospital)H-Index: 4
#2Denis M. Gilmore (Brigham and Women's Hospital)H-Index: 9
Last. Jon O. Wee (Brigham and Women's Hospital)H-Index: 12
view all 7 authors...
Abstract Objective To assess safety and feasibility of an intraoperative, minimally invasive near-infrared (NIR) image-guided approach to lymphatic mapping in patients with esophageal cancer. Methods Although local lymph nodes (LNs) are removed with the esophageal specimen, no techniques are available to identify the regional LNs (separate from the esophagus) during esophagectomy. We hypothesize that NIR imaging can identify regional LNs with the potential to improve staging and guide the extent...
22 CitationsSource
#1Kazuo Koyanagi (Tokai University)H-Index: 2
#1Kazuo KoyanagiH-Index: 17
Last. Yuji TachimoriH-Index: 35
view all 8 authors...
Anastomotic leakage is considered as an independent risk factor for postoperative mortality after esophagectomy, and an insufficient blood flow in the reconstructed conduit may be a risk factor of anastomotic leakage. We investigated the clinical significance of blood flow visualization by indocyanine green (ICG) fluorescence in the gastric conduit as a means of predicting the leakage of esophagogastric anastomosis after esophagectomy.Forty patients who underwent an esophagectomy with gastric co...
23 CitationsSource
#1Yuichiro Nakashima (Kyushu University)H-Index: 17
#2Hidehisa Saeki (Kyushu University)H-Index: 36
Last. Yoshihiko Maehara (Kyushu University)H-Index: 75
view all 10 authors...
Esophagectomy is an invasive surgical procedure with several serious postoperative complications including anastomotic leak. To reduce the incidence of anastomotic leak, it is necessary to establish more reliable techniques for anastomosis.
10 CitationsSource
The present study investigated the visualization of the arterial networks in the stomach (ANS) during gastric tube (GT) creation using indocyanine green fluorescence and the HyperEye Medical System (HEMS), and the feasibility of the HEMS-line-marking method (LMM).We reviewed 51 consecutive patients who had undergone esophageal surgery with GT reconstruction. Patients for whom the HEMS was deployed after GT creation to confirm the anastomosed area's blood supply formed the control group (n=28). P...
13 Citations
#1Takafumi Yukaya (Kyushu University)H-Index: 6
#2Hiroshi Saeki (Kyushu University)H-Index: 30
Last. Yoshihiko Maehara (Kyushu University)H-Index: 75
view all 10 authors...
25 CitationsSource
#1Jörg Zehetner (SC: University of Southern California)H-Index: 14
#2Steven R. DeMeesterH-Index: 53
Last. Tom R. DeMeesterH-Index: 93
view all 7 authors...
Objective:The aim of the study was to evaluate laser-assisted fluorescent-dye angiography (LAA) to assess perfusion in the gastric graft and to correlate perfusion with subsequent anastomotic leak.Background:Anastomotic leaks are a major source of morbidity after esophagectomy with gastric pull-up (
96 CitationsSource
#1Kinji Kamiya (Hamamatsu University)H-Index: 18
#2Naoki Unno (Hamamatsu University)H-Index: 25
Last. Hiroyuki Konno (Hamamatsu University)H-Index: 39
view all 10 authors...
Abstract Background Reconstruction with free jejunal graft (FJG) is often performed for patients with hypopharyngeal or cervical esophageal cancer. During reconstruction with an FJG after pharyngoesophagectomy, it is critical to intraoperatively detect venous anastomotic failure and subsequent venous malperfusion to avoid postoperative FJG necrosis. This study introduces a novel method for assessing blood perfusion in FJGs by using indocyanine green (ICG) fluorescence angiography. Methods We use...
18 CitationsSource
#1Chase Campbell (Carolinas Medical Center)H-Index: 1
#2Mark K. ReamesH-Index: 11
Last. Jonathan C. SaloH-Index: 9
view all 5 authors...
Background Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. A major factor determining anastomotic success is an adequate blood supply to the conduit. The aim of this study was to determine the impact of intraoperative evaluation of the conduit’s vascular supply on anastomotic failure after esophagectomy.
27 CitationsSource
Cited By3
#1Massimo VecchiatoH-Index: 6
#2Antonio MartinoH-Index: 2
Last. Roberto PetriH-Index: 7
view all 7 authors...
: Chylothorax is a serious complication of transthoracic esophagectomy. Intraoperative thoracic duct (TD) identification represents a possible tool for preventing or repairing its lesions, and it is most of the time difficult, even during high-definition thoracoscopy. The aim of the study is to demonstrate the feasibility of using near-infrared fluorescence-guided thoracoscopy to identify TD anatomy and check its intraoperative lesions during minimally invasive esophagectomy. A 0.5 mg/kg solutio...
#1Tamar B. Nobel (Mount Sinai Hospital)H-Index: 8
#1Tamar B. Nobel (Mount Sinai Hospital)H-Index: 1
Last. Daniela Molena (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 25
view all 2 authors...
: The incidence of esophagogastric junction (EGJ) adenocarcinoma is increasing worldwide. Management of these tumors remains controversial given their unique location between the esophagus and the stomach. Debate surrounding the optimal therapy for EGJ adenocarcinoma has often centered around the tumor origin as defined by the Siewert classification system. However, the optimal surgical management should focus on adhering to important surgical principles that will allow for the best outcomes and...
1 CitationsSource
#1Farah Ladak (Brown University)H-Index: 3
#1Farah Ladak (Brown University)H-Index: 1
Last. Shahzeer Karmali (U of A: University of Alberta)H-Index: 33
view all 8 authors...
Background Intraoperative evaluation with fluorescence angiography using indocyanine green (ICG) offers a dynamic assessment of gastric conduit perfusion and can guide anastomotic site selection during an esophagectomy. This study aims to evaluate the predictive value of ICG for the prevention of anastomotic leak following esophagectomy.
17 CitationsSource