Ann Robot Surg | Volume 2, Issue 1 | Surgical Technique | Open Access
Jagdishwar Goud G, Bala Vikas Kumar M and Harika Tirunagari
Department of Surgical Oncology and Robotic Surgery, Apollo Hospitals, Hyderabad, India
Department of Minimal Access Surgery, Apollo Hospitals, Hyderabad, India
*Correspondance to: Harika Tirunagari
Fulltext PDFBackground: Accurate intraoperative identification of the thoracic duct, trachea, and primary tumor is critical in esophagectomy. This study evaluated the feasibility of using Indocyanine Green (ICG) fluorescence imaging during robotic esophagectomy to enhance anatomic visualization. Methods: We conducted a single-center feasibility study involving 32 patients undergoing robotic esophagectomy. ICG was administered intravenously for thoracic duct visualization, via nebulization for tracheal mapping, and through endoscopic or EUS-guided submucosal injection for tumor localization. The Firefly® imaging system, integrated into the da Vinci® robotic platform, was utilized for real-time near-infrared (NIR) fluorescence imaging. Sentinel lymph node (SLN) sampling was attempted where feasible. Results: The thoracic duct was successfully identified in 30 of 32 patients (94%). Tumor localization was achieved in all patients (100%), including those with small or submucosal lesions. SLN sampling was technically feasible and aided targeted nodal dissection in selected cases; however, variability in fluorescence uptake limited its reliability. Tracheal visualization was consistently achieved, though the requirement for reduced ambient illumination in NIR mode posed ergonomic challenges, necessitating intermittent switching to white-light mode during dissection. Conclusions: ICG fluorescence imaging is a feasible and valuable adjunct during robotic esophagectomy, enabling reliable identification of critical anatomical structures such as the thoracic duct and tumor. While SLN mapping shows early promise, it remains an evolving technique. Tracheal dissection under NIR mode may benefit from further ergonomic refinements. Larger studies with long-term follow-up are warranted to evaluate its impact on oncologic outcomes.
Esophageal cancer; Robotic esophagectomy; Indocyanine green; Fluorescence imaging; Thoracic duct; Sentinel lymph node; Firefly®; Near-infrared; Tracheal visualization
Jagdishwar Goud G, Bala Vikas Kumar M, Harika Tirunagari. Intraoperative Visualization of Thoracic Duct, Primary Tumor, and Trachea Using Indocyanine Green Firefly Mode During Robotic Esophagectomy: A Feasibility Study. Ann Robot Surg. 2025; 2(1):1005..