Novel thoracoscopic navigation surgery for neonatal chylothorax using indocyanine-green fluorescent lymphography
Autor: | Kosuke Chiba, Hiroo Uchida, Akinari Hinoki, Chiyoe Shirota, Takahisa Tainaka, Naruhiko Murase, Yujiro Tanaka, Kazuo Oshima, Masahiro Hayakawa, Kazuki Yokota, Ryo Shirotsuki, Wataru Sumida |
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Rok vydání: | 2017 |
Předmět: |
Indocyanine Green
Male medicine.medical_specialty medicine.medical_treatment Tracheoesophageal fistula Chylothorax Thoracic duct Thoracic Duct 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Postoperative Complications medicine Humans Coloring Agents Esophageal Atresia Ligation Retrospective Studies business.industry Thoracoscopy Infant Newborn Lymphography General Medicine medicine.disease Ablation Surgery medicine.anatomical_structure chemistry 030220 oncology & carcinogenesis Atresia Pediatrics Perinatology and Child Health 030211 gastroenterology & hepatology Female Azygos vein business Complication Indocyanine green Tracheoesophageal Fistula |
Zdroj: | Journal of pediatric surgery. 53(6) |
ISSN: | 1531-5037 |
Popis: | Background Postoperative chylothorax after surgery for esophageal atresia/tracheoesophageal fistula (TEF) is a rare but serious complication, especially in neonates. This study aimed to identify the thoracic duct and ligate chylous leakage sites, using thoracoscopic navigation of an indocyanine-green (ICG)-based near-infrared (NIR) fluorescence imaging system. Methods From November 2014 to April 2017, thoracoscopic intraoperative ICG-NIR imaging was performed in 10 newborns (11 surgeries) with first TEF operation or with persistent postoperative chylothorax after TEF operation. NIR imaging was performed 1 h after an inter-toe injection of ICG. Thoracoscopic ligations against the NIR-detected leakage sites were performed with sutures. Results The thoracic duct or lymphatic leakage was directly visualized in each patient. In 8 surgeries with first thoracoscopic TEF operation, one case had suspected minor chylous leakage without postoperative chylothorax. Another case with no chylous leakage at the first operation resulted in chylothorax at postoperative day 11. In three neonates with postoperative chylothorax, leakage points were detected near the ablation site of the azygos vein during the first operation. These points were properly ligated, and postoperative chylous leakage ceased with no adverse events. Conclusions Thoracoscopic ICG-NIR imaging encourages the repair of refractory chylothorax and seems reliable. Level of Evidence IV |
Databáze: | OpenAIRE |
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