INDOCYSTINE GREEN LYMPHANGIOGRAPHY FOR IDENTIFICATION OF THORACIC DUCT LEAK cristiangar789@gmail.com

462-06

INDOCYSTINE GREEN LYMPHANGIOGRAPHY FOR IDENTIFICATION OF THORACIC DUCT LEAK

5

 

 

 

 

Maldives

Oral or Poster

The management of postoperative chylothorax in patients with adenocarcinoma can be challenging due to the anatomical variability of the thoracic duct. Indocyanine green (ICG) is a tool for intraoperative CT mapping and complication prevention. ICG allows identification of the thoracic duct in up to 93% of cases, with a significant reduction in the incidence of postoperative injuries or leaks compared to procedures without this guide. A dose of 0.05 to 0.5 mg/kg is administered to the inguinal lymph nodes or subcutaneous tissue of the inguinal region 30 minutes to 1 hour before the procedure for proper visualization.

A 68-year-old male was diagnosed with poorly differentiated acinar lung adenocarcinoma with a lepidic pattern, ILV (+), and invasion through air spaces. Postoperatively, a right chylothorax was seen, confirmed by lymphangiography, which showed contrast medium leakage from aberrant branches near station 7 of the mediastinal lymph nodes.

Unresponsive to conservative management, the patient was scheduled for video-assisted thoracoscopy, lung clearance, drainage of the right pleural effusion, and thoracic duct ligation with indocyanine green. 5 ml of a 1 mg/ml solution was administered into the right inguinal lymph node.

The fluorescence provided by ICG facilitates precise ligation, even in complex anatomical situations. Clinical evidence supports its usefulness, showing a 0% postoperative complication rate in ICG-guided patients, compared to more than 12% in control groups.