BACKGROUND: This video highlights a successful method to confidently locate the thoracic duct (TD) for ligation using indocyanine green (ICG) in the treatment of postoperative chylothorax. Near-infrared (NIR) fluorescence imaging with ICG provides real-time identification of the TD and any associated aberrant anatomy. NIR-ICG fluorescence imaging to localize the TD for chylothorax is an innovative technology that has been successfully described in case reports, case series, and retrospective studies.
METHODS: We present a detailed video of how to use NIR fluorescence imaging with ICG to easily visualize the thoracic duct by injecting ICG pre-operatively into bilateral inguinal lymph nodes. The patient is a 68 year old female who developed recurrent right chylothorax one month after robotic-assisted right thoracoscopy, right middle lobectomy, and mediastinal lymph node dissection. The NIR fluorescence imaging with ICG clearly showed an unusual triple system thoracic duct which may have been incompletely ligated without the help of ICG.
RESULTS: The thoracic duct was clearly visualized which enabled its efficient and accurate ligation. The patient was discharged on postoperative day three without complications and follow-up chest x-ray in clinic showed no pleural effusion.
CONCLUSIONS: This video demonstrates the efficacy of ICG injection into bilateral inguinal lymph nodes to safely and efficiently localize and precisely ligate the thoracic duct with good postoperative outcomes.
