Thoracic duct identification using three-dimensional thoracoscope versus indocyanine green fluorescence during minimally invasive esophagectomy: a retrospective cohort study

Background: Chylothorax following esophagectomy is a frustrating complication with considerable morbidity. In addition, recognizing the morphological patterns of the thoracic duct (TD) holds great significance. This study was aimed at explore the safety and efficacy of three-dimensional (3D) thoracoscope in comparison with indocyanine green (ICG) fluorescence to identify TD during minimally invasive esophagectomy (MIE) for esophageal cancer.

Methods: A totally 354 esophageal cancer patients undergoing MIE in a single center between January 2019 and August 2023 were retrospectively analyzed, including 179 cases using fluorescent laparoscopy (the ICG group) and 175 cases with 3D laparoscopy (the 3D group). The baseline and perioperative parameters such as operation time and the TD-related complications were compared.

Results: Intraoperative recognition rate of the TD in the ICG group was higher than that of the 3D group (98.9% vs. 96.0%), although without a significant difference. Both groups demonstrated similar operation time, estimated blood loss, chest tube drainage, the incidence of postoperative complications and the length of postoperative hospital stay, with P>0.05, respectively. Meanwhile, the ICG group showed better prevention efficacy of the TD ligation. Furthermore, the incidence of complications was not significantly different between the two groups. ICG-specified side effect was not found in this cohort.

Conclusions: The ICG-guided fluorescent laparoscopy as well as the 3D thoracoscope as a simple and safe method is probably sufficient to identify the TD in real-time, which can serve as a potent tool for preventing TD injuries during MIE.