The Intraoperative Visualization of Recurrent Laryngeal Nerve Using Indocyanine Green Near-Infrared Fluorescence Imaging in Minimally Invasive Esophageal Cancer Resection

Background Esophageal cancer is a common malignant tumor of the digestive tract, and surgery is an effective treatment option. Recurrent laryngeal nerve paralysis is a common postoperative complication following minimally invasive esophageal cancer resection. There is currently no unified and effective method for recurrent laryngeal nerve protection. This study aims to explore the protective effect of indocyanine green (ICG) near-infrared fluorescence imaging technology on the recurrent laryngeal nerve during minimally invasive esophageal cancer resection. Methods Patients diagnosed with esophageal cancer (either squamous cell carcinoma or adenocarcinoma) were managed with routine perioperative care. ICG was intravenously infused 12–24 hours prior to surgery. During the operation, when performing lymph node dissection adjacent to the recurrent laryngeal nerve, thoracoscopic fluorescence imaging was activated to observe whether the left and right recurrent laryngeal nerves could be successfully visualized. Lymph node dissection adjacent to the recurrent laryngeal nerve was then conducted under fluorescence imaging. Postoperatively, from 1 to 3 days, patients were monitored for clinical symptoms related to recurrent laryngeal nerve injury, such as hoarseness and difficulty swallowing. Results A total of 12 cases of recurrent laryngeal nerve-adjacent lymph node dissection were performed under guidance of indocyanine green near-infrared fluorescence imaging, with successful visualization in 10 cases. In the successfully visualized cases, both the left and right recurrent laryngeal nerves, as well as the vagus and sympathetic nerves in the cervical and upper thoracic regions, were visualized during the surgery. None of the patients with successful nerve visualization exhibited any postoperative recurrent laryngeal nerve injury symptoms. Conclusion Indocyanine green near-infrared fluorescence imaging is a feasible and effective method for protecting the recurrent laryngeal nerve during minimally invasive esophageal cancer resection.