Background: Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during\nesophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence\nimaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery.\nWe used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.\nMethods: Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic\nesophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg\nof ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the\nimages were recorded.\nResults: ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well\nvisualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside\nthe splenic hilum in 22 (66.7%) of the 33 patients.\nConclusions: ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in\npatients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal\nvessels were the major blood supply for the anastomosis in most patients.
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