# Intraoperative Fluorescent Imaging with Indocyanine Green during Thoracoscopic Esophagectomy with Subcarinal Lymph Node Dissection for Esophageal Cancer with a Right Superior Pulmonary Vein Anomaly: A Case Report and Literature Review

## TL;DR

A case report shows how fluorescent imaging helped safely perform lymph node dissection in a patient with esophageal cancer and a rare vein anomaly.

## Contribution

Demonstrates the utility of intraoperative fluorescent imaging with indocyanine green in managing anatomical anomalies during esophagectomy.

## Key findings

- Fluorescent imaging accurately identified the anomalous right superior posterior pulmonary vein during surgery.
- The technique facilitated safe lymph node dissection without vascular injury in a complex anatomical case.
- Intraoperative imaging proved valuable for real-time anatomical guidance in thoracoscopic esophagectomy.

## Abstract

A 68-year-old woman was diagnosed with clinical T3N1M0 middle thoracic esophageal cancer. Preoperative three-dimensional computed tomography indicated a right superior posterior pulmonary vein (RSPPV) anomaly, which ran behind the right intermediate bronchus. The patient underwent thoracoscopic esophagectomy with mediastinal lymph node (LN) dissection. Before we began the dissection of the right subcarinal LN, we administered indocyanine green intravenously to confirm the running position of the anomalous RSPPV, and we were able to ascertain its placement accurately with correct recognition of the difference between the blood vessels and surrounding tissue. Although the patient had LN metastasis adjacent to this anomalous vessel and the dissection procedure was tough due to tightly adhesion, intraoperative fluorescent imaging enabled us to perform the dissection without any superfluous vascular injury. Intraoperative fluorescent imaging is very useful in such cases, providing accurate intraoperative information on the location of the anomaly and facilitating safer surgery.