V-16. Improving Safety in Left RLN Node Dissection: Esophageal Retraction With ICG-Guided Thoracic Duct Visualization

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ID: 325753
2026
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Ranked #124 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Left recurrent laryngeal nerve (RLN) node dissection during video-assisted thoracoscopic surgery (VATS) is technically demanding due to the proximity of vital structures and risk of nerve injury. Conventional suspension of the esophagus via the chest wall can be cumbersome and may limit visualization. Incorporating real-time indocyanine green (ICG) dye visualization of the thoracic duct offers an opportunity to enhance safety and precision. Methods We demonstrate 106Lt.RLN dissection by retracting esophagus in a patient with lower third locally advanced esophageal squamous cell cancer who received three cycles of neoadjuvant DCF regimen. A four-port VATS MIE was performed with cervical anastomosis. Results Left RLN area was dissected in the last part of the thoracic phase. The trachea and left bronchial junction were retracted anteriorly, the parietal layer was opened, and paratracheal tissue was dissected. A combination of monopolar hook, scissor, and advanced energy source facilitated dissection. Fibrofatty tissue was lifted in parts, with Maryland forceps used to dissect within the visceral layer to identify the RLN. Real-time ICG visualization delineated the thoracic duct, making posterior dissection safer and more controlled, particularly over the aortic arch and left subclavian artery. The esophageal retraction method provided stable exposure without chest wall suspension, facilitating precise identification and preservation of the RLN. The average time for this part was 25 minutes. Conclusion This video highlights the utility of esophageal retraction combined with ICG-guided thoracic duct visualization in VATS left RLN node dissection. The technique enhances safety, improves anatomical clarity, and supports meticulous nerve preservation, offering a valuable refinement. Video Description This surgical video is distinctive for three key reasons: 1. It exclusively demonstrates the left recurrent laryngeal nerve node dissection component of the VATS procedure. 2. It introduces the esophageal retraction method, in contrast to the traditional suspension technique, thereby offering improved exposure and workflow efficiency. 3. It incorporates indocyanine green guidance for real-time visualization of the thoracic duct, enhancing safety during dissection.
Reference Key
openalex_W7203937613 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Shiv Rajan
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.416
URL
https://doi.org/10.1093/dote/doag077.416
Keywords Keywords not found

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