Evaluation of indocyanine green tracheobronchial fluorescence (ICG-TBF) via nebulization during minimally invasive esophagectomy.

Subramanyeshwar Rao Thammineedi, Sujit Chyau Patnaik, Syed Nusrath, Vibhavari Naik, Basanth Rayani, Pratap Reddy Ramalingam, Yogesh Vashist, Srijan Shukla
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Abstract

Surgical manipulation of the tracheobronchial complex is a contributing factor in pulmonary morbidity of esophagectomy. Accurate dissection between membranous trachea and bronchi with esophagus is essential. This study tests the feasibility of delivering indocyanine green (ICG) in an aerosol form to achieve tracheobronchial fluorescence (ICG-TBF). Patients with esophageal and esophagogastric junction carcinoma (N = 37) undergoing minimally invasive esophagectomy (McKeown type) were included. ICG was aerosolized by nebulization in supine position before thoracoscopy. ICG-TBF was observed with real-time fluorescence-enabled camera. Intra- and postoperative complications related to ICG were the primary focus. ICG-TBF was identified in 94.6% (35/37) of patients with median time to fluorescence identification of 15 minutes (range 1-43). There were no airway injuries in the study. The ICU median stay was 2 (range 2-21) days. No intra- or postoperative complications attributable to ICG were observed. Grade 3 or 4 pulmonary complications were seen in total 8.1% patients. No 90-day postoperative mortality was seen. ICG delivered in aerosol form was found to be safe and effective in achieving ICG-TBF. It aided in accurate dissection of esophagus from the tracheobronchial complex. Further studies on effect of ICG-TBF in decreasing pulmonary complications of esophagectomy are needed.

在微创食管切除术中通过雾化对吲哚菁绿气管支气管荧光(ICG-TBF)进行评估。
对气管支气管复合体的手术操作是食管切除术导致肺部发病的一个因素。准确解剖膜质气管和支气管与食管之间的关系至关重要。本研究测试了以气溶胶形式递送吲哚菁绿(ICG)以实现气管支气管荧光(ICG-TBF)的可行性。研究对象包括接受微创食管切除术(麦氏型)的食管癌和食管胃交界癌患者(37 人)。在胸腔镜手术前仰卧位雾化 ICG。使用实时荧光摄像机观察 ICG-TBF。与ICG相关的术中和术后并发症是主要关注点。94.6%的患者(35/37)发现了ICG-TBF,荧光识别的中位时间为15分钟(范围1-43)。研究中没有气道损伤。重症监护室的中位住院时间为 2 天(2-21 天)。未观察到可归因于 ICG 的术中或术后并发症。8.1%的患者出现了3级或4级肺部并发症。术后 90 天无死亡病例。研究发现,以气雾剂形式给药的 ICG 在实现 ICG-TBF 方面安全有效。它有助于从气管支气管复合体中准确剥离食管。还需要进一步研究 ICG-TBF 对减少食管切除术肺部并发症的效果。
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