{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:38Z","timestamp":1753893278868,"version":"3.41.2"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Chylothorax is a rare but potentially life-threatening condition characterized by the accumulation of lymphatic fluid in the pleural cavity. It is typically managed with conservative treatments such as fasting and\/or thoracic duct embolization via lymphography. However, when these approaches fail, surgical intervention, most commonly thoracic duct ligation (TDL), is often necessary. While the advent of video-assisted thoracoscopic surgery (VATS) has enabled minimal invasive approaches for thoracic duct ligation, intraoperative identification of the thoracic duct remains technically challenging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>We present the case of a 62-year-old man diagnosed with SMARCB1-deficient mediastinal sarcoma who underwent left pneumonectomy and subsequently developed a left-sided chylothorax on postoperative day 16. Initial management with conservative strategy first, including two lymphography procedures with attempted embolization, was unsuccessful. Consequently, we proceeded with thoracic duct ligation via right-sided VATS, employing indocyanine green (ICG) fluorescence to aid in the identification of the thoracic duct. Given the prior left pneumonectomy, a single-lumen endotracheal tube with a bronchial blocker was used to selectively exclude the right lower lobe during the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case highlights the use of ICG fluorescence in facilitating the identification and ligation of the thoracic duct in a patient with left-sided chylothorax following left pneumonectomy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1558519","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T12:30:03Z","timestamp":1745929803000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Thoracic duct ligation for left-sided chylothorax after pneumonectomy with contralateral VATS procedure using indocyanine green fluorescence"],"prefix":"10.3389","volume":"12","author":[{"given":"Chiara Anna","family":"Schiena","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Pezzella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Faccioli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Rebusso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Comacchio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Silvestrin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Battistel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Rosellini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Dell\u2019Amore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Rea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuele","family":"Nicotra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1016\/j.chest.2022.06.012","article-title":"Multidisciplinary 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