Usefulness of indocyanine green fluorescence-based optical imaging for repair of pleuroperitoneal communication

Surgical treatment of pleuroperitoneal communication requires reliable identification of the fistula. In this report, we present a case of successful identification of the fistula using indocyanine green (ICG) dye with infrared thoracoscopy. The patient was a 53-year-old male suffering from massive ascites, diagnosed with renal sclerosis on hemodialysis and liver cirrhosis due to non-alcoholic steatohepatitis. Examination revealed a massive right pleural effusion, when the patient complained of cough and shortness of breath. He was diagnosed with pleuroperitoneal communication, and thoracoscopic surgery was performed. ICG solution was injected through a peritoneal catheter inserted on the day before surgery. Although only a subtle change was detected under natural light, leakage of the dye from a fistula was clearly confirmed using infrared thoracoscopy. The fistula was excised using an endostapler, and the staple line was covered with a polyglycolic acid sheet and fibrin glue. This method was useful for detection of the fistula during surgical repair of pleuroperitoneal communication.