Intraoperative near-infrared fluorescence imaging as an adjunct to robotic-assisted minimally invasive esophagectomy Journal Article


Authors: Sarkaria, I. S.; Bains, M. S.; Finley, D. J.; Adusumilli, P. S.; Huang, J.; Rusch, V. W.; Jones, D. R.; Rizk, N. P.
Article Title: Intraoperative near-infrared fluorescence imaging as an adjunct to robotic-assisted minimally invasive esophagectomy
Abstract: During esophagectomy, identification and preservation of the right gastroepiploic vascular arcade are critical and may be challenging with minimally invasive approaches. We assessed the use of near-infrared fluorescence imaging fluorescence angiography (NIFIFA) during robotic-assisted minimally invasive esophagectomy (RAMIE) as an aid to visualize the gastric vasculature with mobilization. After intravenous administration of 10 mg of indocyanine green, a robotic platform with near-infrared optical fluorescence capability was used to examine the gastric vasculature in patients undergoing RAMIE. Thirty (71%) of 42 patients undergoing RAMIE were assessed using NIFI-FA during mobilization of the greater gastric curve and fundus; 11 were excluded because the system was not available, and 1 was excluded because of documented allergy to iodinated contrast. The median time from indocyanine green administration to detectable fluorescence was 37.5 seconds (range, 20-105 seconds). Near-infrared fluorescence imaging FA identified or confirmed termination of the vascular arcade in all 30 cases. Subjectively, NIFI-FA often identified otherwise unvisualized small transverse vessels between the termination of the vascular arcade and the first short gastric artery, as well as between the short gastric arteries. Identification and/or confirmation of the vascular arcade position during mobilization of the greater curve/omentum were also aided by NIFI-FA. Although there are limitations to the current technology, NIFI-FA may be a useful adjunct to confirm and identify the position of gastroepiploic vessels, allow for safer and more confident dissections during gastric mobilization, as well as potentially decrease serious intraoperative vascular misadventures. Copyright © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery.
Keywords: angiography; esophagectomy; fluorescence imaging; esophageal cancer; robotic surgery
Journal Title: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume: 9
Issue: 5
ISSN: 1556-9845
Publisher: Lippincott Williams & Wilkins  
Date Published: 2014-09-01
Start Page: 391
End Page: 393
Language: English
PROVIDER: scopus
PUBMED: 25238427
DOI: 10.1097/IMI.0000000000000091
PMCID: PMC5523952
DOI/URL:
Notes: Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery; 2013 Jun 12–15; Prague, Czech Republic -- Export Date: 4 May 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Valerie W Rusch
    663 Rusch
  2. Nabil Rizk
    134 Rizk
  3. James Huang
    120 Huang
  4. David John Finley
    39 Finley
  5. Manjit S Bains
    231 Bains
  6. David Randolph Jones
    155 Jones