Thoracoscopic near-infrared localization and division of H-type tracheoesophageal fistulas in newborns: A case series

PURPOSE: Congenital H-type tracheoesophageal fistula (H-TEF) is a rare congenital esophageal malformation. Treatment involves minimally invasive surgery; however, accurate fistula localization remains challenging. Real-time imaging via near-infrared (NIR) thoracoscopy facilitates the distinction between different tissue structures. Therefore, we aimed to evaluate the clinical efficacy of the NIR-thoracoscopic simple clip method for treating congenital H-TEFs in neonates. METHODS: Neonates with H-TEFs underwent thoracoscopic NIR localization using indocyanine green (ICG) injection, followed by clipping and division. The inclusion criteria were: (1) H-TEF confirmed by esophagography and/or bronchoscopy, (2) fistula below T2 level, (3) birth weight ≥2.0 kg, and (4) parental consent. The exclusion criteria were: (1) severe cardiopulmonary malformations/coagulopathy, (2) prior TEF repair, and (3) surgical contraindications. After successful general anesthesia, the patient was placed in the supine position, and ICG (0.1 mg/mL) was injected into the fistula lumen under bronchoscopic guidance. The patient was then moved to the right supine position for the thoracoscopic surgery. RESULTS: Six neonates (male: 4, female: 2; median operative age: 7 days, range: 3-15 days; birth weight: 2.8 kg, range: 2.1-3.5 kg). They presented with dyspnea (6/6), cyanosis during feeding (6/6), and persistent pulmonary infection (4/6). The median operative time was 65 min (range: 53-77 min), and blood loss was