Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 3 Date: 23 Jun 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
In this publication, the authors describe how they were able to clearly visualize recurrent trachea-
esophageal fistulae (rTEF) after esophageal atresia (EA) repair. Prior to the thoracoscopic rTEF
correction an indocyanine green (ICG) solution is sprayed in the fistula under bronchoscopic
guidance. With subsequent fluorescence imaging during the thoracoscopic dissection, the rTEF
can be identified and extensive dissection can be avoided.
Surgery for rTEF can be cumbersome, due to strong adhesions and local scar tissue formation.
Also identifying the rTEF and finding the plane between the trachea and the proximal esophagus
can be challenging, even for experienced surgeons. I believe that the suggested ICG fluorescence
rTEF identification could really be of help.
I have some comments:
- Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
- rTEF operation
Please describe clearly how much ICG fluid is sprayed into the fistula, how much was it diluted
with sterile water? How was it sprayed into the fistula?
What tissue was used to create two separate layers of pedicle flaps?
Delayed esophageal closure: Please ad:   …after earlier failure of primary anastomosis
How is the ICG infused into the distal pouch?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
- Discussion
ICG skin tests were performed because the agent contained iodine…
Please describe the test in the Materials and Methods section
Much of the ICG was suctioned? How was this done? In what stage of the surgery? Please
describe this in the Materials and Methods section
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
References:
Ref 5: undefined? Should be (9)…
Ref 13: please delete ref 9…..
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture?
Figure 2
Please describe how the image is made? E.g. thoracoscopic view with- or without fluorescence,
and indicate on each image what is esophagus and what is trachea
Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 3 Date: 23 Jun 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
In this publication, the authors describe how they were able to clearly visualize recurrent trachea-
esophageal fistulae (rTEF) after esophageal atresia (EA) repair. Prior to the thoracoscopic rTEF
correction an indocyanine green (ICG) solution is sprayed in the fistula under bronchoscopic
guidance. With subsequent fluorescence imaging during the thoracoscopic dissection, the rTEF
can be identified and extensive dissection can be avoided.
Surgery for rTEF can be cumbersome, due to strong adhesions and local scar tissue formation.
Also identifying the rTEF and finding the plane between the trachea and the proximal esophagus
can be challenging, even for experienced surgeons. I believe that the suggested ICG fluorescence
rTEF identification could really be of help.
I have some comments:
- Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
- rTEF operation
Please describe clearly how much ICG fluid is sprayed into the fistula, how much was it diluted
with sterile water? How was it sprayed into the fistula?
What tissue was used to create two separate layers of pedicle flaps?
Delayed esophageal closure: Please ad:   …after earlier failure of primary anastomosis
How is the ICG infused into the distal pouch?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
- Discussion
ICG skin tests were performed because the agent contained iodine…
Please describe the test in the Materials and Methods section
Much of the ICG was suctioned? How was this done? In what stage of the surgery? Please
describe this in the Materials and Methods section
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
References:
Ref 5: undefined? Should be (9)…
Ref 13: please delete ref 9…..
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture?
Figure 2
Please describe how the image is made? E.g. thoracoscopic view with- or without fluorescence,
and indicate on each image what is esophagus and what is trachea
Please review this paper.
user
Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 3 Date: 23 Jun 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
In this publication, the authors describe how they were able to clearly visualize recurrent trachea-
esophageal fistulae (rTEF) after esophageal atresia (EA) repair. Prior to the thoracoscopic rTEF
correction an indocyanine green (ICG) solution is sprayed in the fistula under bronchoscopic
guidance. With subsequent fluorescence imaging during the thoracoscopic dissection, the rTEF
can be identified and extensive dissection can be avoided.
Surgery for rTEF can be cumbersome, due to strong adhesions and local scar tissue formation.
Also identifying the rTEF and finding the plane between the trachea and the proximal esophagus
can be challenging, even for experienced surgeons. I believe that the suggested ICG fluorescence
rTEF identification could really be of help.
I have some comments:
- Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
- rTEF operation
Please describe clearly how much ICG fluid is sprayed into the fistula, how much was it diluted
with sterile water? How was it sprayed into the fistula?
What tissue was used to create two separate layers of pedicle flaps?
Delayed esophageal closure: Please ad:   …after earlier failure of primary anastomosis
How is the ICG infused into the distal pouch?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
- Discussion
ICG skin tests were performed because the agent contained iodine…
Please describe the test in the Materials and Methods section
Much of the ICG was suctioned? How was this done? In what stage of the surgery? Please
describe this in the Materials and Methods section
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
References:
Ref 5: undefined? Should be (9)…
Ref 13: please delete ref 9…..
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture?
Figure 2
Please describe how the image is made? E.g. thoracoscopic view with- or without fluorescence,
and indicate on each image what is esophagus and what is trachea
assistant