236. INDOCYANINE GREEN TRACHEOBRONCHIAL FLUORESCENCE (ICG-TBF) VIA NEBULIZATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY -A NOVEL TECHNIQUE

Keywords

ICG, fluorescence guided surgery, esophagectomy, ICG nebulization, ICG-TBF, tracheobronchial fluorescence.

Abstract

Background

Surgical manipulation of 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).

Methods

Patients with esophageal and esophagogastric carcinoma undergoing minimally invasive esophagectomy (McKeowns type) were included. ICG was aersolized by nebulisation in supine position before thoracoscopy. ICG-TBF was observed with real time fluorescence enabled camera. Intraoperative and postoperative complications related to ICG were noted.

Results

37 patients were included in the study. ICG-TBF was identified in 94.6% (35/37) of patients with mean time to fluorescence identification of 13 minutes (1–43). There were no airway resections/injuries in the study. No intraoperative or postoperative complications attributable to ICG were observed. No 90 day postoperative mortality was seen.

Conclusions

ICG delivered in aerosol form was found to be safe and effective in achieving ICG-TGF. Further studies on effect of ICG-TBF in decreasing pulmonary complications of esophagectomy are needed.