# Fiber-Guided Red Light-Emitting Diode Localization of an Esophageal Blind End in Long-Gap Esophageal Atresia Surgery: A Case Report

## TL;DR

A new technique using fiber-guided red LED light helps locate the lower blind end of the esophagus during complex birth defect surgery.

## Contribution

Demonstrates the successful use of Tumguide for intraoperative localization in long-gap esophageal atresia.

## Key findings

- Tumguide enabled clear localization of the lower esophageal blind end in a long-gap EA case.
- The technique minimized tissue dissection and reduced surgical risks like anastomotic stricture.
- Fiber-guided red LED illumination proved safe and effective for intraoperative guidance.

## Abstract

Esophageal atresia (EA) Gross type A is a congenital malformation in which both the upper and lower esophagus have blind ends without a tracheoesophageal fistula. The gap between the segments is often long (long-gap EA), making intraoperative localization challenging. We report a case in which the lower esophageal blind end was readily localized using Tumguide (Otsuka Pharmaceutical Factory, Tokushima, Japan), a device that transmits biologically transparent red light from a light-emitting diode (LED) through an optical fiber.

The patient was a 2-month-old girl diagnosed at birth with EA Gross type A. A gastrostomy was performed shortly after birth, and esophageal lengthening with the Howard procedure was carried out over the following month. At 2 months of age, she underwent delayed primary esophageal anastomosis. At the start of surgery, the Tumguide was inserted through the gastrostomy site into a Salem Sump gastric drainage tube. The device provided clear localization of the lower esophageal blind end, minimizing the need for dissection of surrounding tissues.

Fiber-guided red LED illumination, using Tumguide, enabled safe and straightforward intraoperative localization of the esophageal blind end in long-gap EA Gross type A. This approach minimized the need for dissection, thereby reducing the risks of injury to surrounding tissues and postoperative complications such as anastomotic stricture and leakage.