Endoscopic evaluation of gastric conduit perfusion in minimally invasive Ivor Lewis esophagectomy

Highlights

• Indocyanine green fluorescent imaging enables visualization of gastric conduit perfusion in real time.

• Endoscopic ICG fluorescent imaging enables a minimally invasive assessment of gastric conduit perfusion and esophagectomy completion.

• Minimally invasive esophagectomy using endoscopic ICG fluorescent imaging is a safe and time efficient procedure.

Abstract

Introduction

Laser-assisted indocyanine green (ICG) fluorescent dye angiography has been used in esophageal reconstructive surgery where it has been shown to significantly decrease the anastomotic leak rate. Recent advances in technology have made this possible in minimally invasive esophagectomy.

Presentation of case

We present a 69-year-old male with a cuT2N0M0 adenocarcinoma of the esophagus at the gastroesophageal junction who presented to our clinic after chemoradiation and underwent a minimally invasive Ivor Lewis esophagectomy. The perfusion of the gastric conduit was assessed intraoperatively using endoscopic ICG fluorescent imaging system. The anastomosis was created at the well-perfused site identified on the fluorescent imaging. The patient tolerated the procedure well, had an uneventful recovery going home on postoperative day 6 and tolerating a regular diet 2 weeks after the surgery.

Discussion

Combination of minimally invasive surgery and endoscopic evaluation of perfusion of gastric conduit provide improved outcomes for surgical treatment for patients with esophageal cancer.

Conclusion

The gastric conduit during minimally invasive Ivor Lewis esophagectomy can be evaluated using endoscopic ICG fluorescent imaging.