Fluorescence Guided Thoracic Duct Dissection in Robotic En-bloc Esophagectomy.

Abstract En-bloc resection of the thoracic duct compartment enhances adequate lymph node removal and may improve oncological outcomes in esophagectomy for esophageal malignancies. However, it also increases the risk of postoperative chylothorax with a reported incidence of 5-20%. We describe a technique that facilitates intraoperative identification of the thoracic duct as well as proximal and distal ligation during robot-assisted esophagectomy by lymphangiography guided injection of indocyanine green in de right groin in left lateral positioning. This approach can be swiftly applied at any time during any thoracoscopic procedure in lateral position when visualization of the thoracic duct anatomy is needed.