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Is Indocyanine Green the New Gold Standard for Checking Completion of Laparoscopic Heller's Cardiomyotomy?
Jainil Patel1, Vishakha Kalikar1, Roysuneel Patankar1
1Department of Surgery, Zen Hospital, Mumbai, IND.
Insights
This study introduces indocyanine green (ICG) dye as a safe and effective method to confirm complete myotomy and prevent mucosal tears during laparoscopic Heller
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Achalasia cardia is an esophageal motility disorder characterized by absent peristalsis and failed lower esophageal sphincter relaxation.
- Laparoscopic Heller's cardiomyotomy with Dor's fundoplication is the standard surgical treatment.
- Risks include incomplete myotomy and mucosal perforation, leading to symptom recurrence.
Purpose of the Study:
- To evaluate the utility of intraluminal indocyanine green (ICG) dye during laparoscopic Heller's cardiomyotomy.
- To assess ICG dye's effectiveness in verifying myotomy completeness and detecting mucosal perforations.
- To present a case series of patients undergoing this innovative technique.
Main Methods:
- A case series of 15 patients with achalasia cardia undergoing laparoscopic Heller's cardiomyotomy with Dor's fundoplication.
- Intraoperative use of intraluminal indocyanine green (ICG) dye.
- Assessment of myotomy completeness and mucosal integrity using ICG fluorescence.
Main Results:
- Indocyanine green (ICG) dye facilitated intraoperative assessment of myotomy.
- The technique allowed for confirmation of complete myotomy and detection of mucosal integrity.
- No complications related to ICG dye administration were reported in the series.
Conclusions:
- Intraluminal indocyanine green (ICG) dye is a valuable tool for laparoscopic Heller's cardiomyotomy.
- It enhances surgical safety by ensuring myotomy completeness and preventing mucosal injury.
- ICG dye offers a promising alternative to traditional methods for intraoperative assessment.
Abstract:
Achalasia cardia is a primary motility disorder of the esophagus marked by the absence of peristalsis and the failure of the lower esophageal sphincter (LES) to relax during swallowing. The preferred surgical approach is laparoscopic Heller's cardiomyotomy with Dor's fundoplication. Given the significant risks of mucosal perforation and the possibility of incomplete myotomy, which can lead to symptom recurrence, it is essential to ensure both the completeness of the myotomy and the preservation of the mucosal integrity. In this study, we present a case series of 15 patients diagnosed with achalasia cardia who underwent laparoscopic Heller's cardiomyotomy with Dor's fundoplication. Intraoperatively, we utilized intraluminal administration of indocyanine green (ICG) dye as an alternative to endoscopy to assess the completeness of the myotomy and to check for any mucosal perforations.
