Management of Postoperative Left-Sided Chylothorax Using Indocyanine Green Fluorescence-Guided VATS

Chylothorax is a rare complication occurring after cardio-thoracic surgical procedures. This condition presents challenges about diagnosis and treatment. Operative ductal ligation is the method of choice for relapsing or refractory cases, and it can be performed through the aid of IGC injection for the identification of chylous leakage. Our report presents the use of ICG fluorescence during VATS to successfully identify and treat a left-sided post-surgical chylothorax. The patient underwent a pulmonary wedge resection for a suspect malignant lesion and developed chylous leakage in the early postoperative period. On postoperative day 7 the patient underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. ICG injections have been performed through bilateral inguinal lymph nodes and approximately 15 minutes after we performed the re-thoracoscopy with effective identification and ligation of the chyle leakage. ICG fluorescence-guided VATS is a valuable and effective method for managing postoperative chylothorax, especially for left-sided leaks. The video of the procedure can be found at: https://zenodo.org/records/13786288