Infrared illumination during thoracoscopic excision of mediastinal bronchogenic cysts

Bronchogenic cysts are congenital abnormalities that occur due to abnormal development of the ventral foregut. Most share a common wall with the esophagus. Excision is indicated to prevent complications such as mass effect or infection. Thoracoscopic resection has been previously described. Injury to the adjacent esophagus is a potential complication due to its close proximity, and placement of an esophageal bougie is often used to help identify the esophagus. We describe a technique utilizing the InfraVision Esophageal Kit (Stryker Endoscopy, San Jose, California) to assist in the illumination of the esophagus during dissection of mediastinal bronchogenic cysts in 3 children. The system consists of an infrared light-emitting probe and an infraredsensing endoscopic camera. The probe is easily placed prior to surgery, and allows for easy identification of the esophagus. It also clarifies the dissection plane between the cyst and the esophagus. This technique facilitates dissection of mediastinal cysts and helps avoid injury to the esophagus. It was found to be safe and effective in 3 children. The system may be applicable to other esophageal operations such as Nissen fundoplication or Heller myotomy.