Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 4 Date: 14 Jul 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
Thank you. Sure, you are right. In this article, I mean the case was fail to anastomose the
esophageal pouches after attempts, which was the unintended results. That was so complicated
to revision surgery. I have modified the text.
Please change delayed primary closure into failed primary anastomosis……
The common condition requiring surgical repair include recurrent tracheoesophageal fistula
(rTEF), which occurs in up to 5%-14% of patients,1,2 and failed primary anastomosis.
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?
Thank you. 0.625mg ICG (0.5 ml, concentration 1.25 mg/ml) diluted with sterile water was
infused into the devices tube of bronchoscope by the syringe. And then 5-10ml air was infused
after that to sprayed the ICG to the fistulae.
Can you include the whole text in the document? I think these details can help other centers to
apply your method.
What tissue was used to create two separate layers of pedicle flaps? Thank you. They are
mediastinal connective tissue or lymph nodes nearby.
Please add these details to the text
Delayed esophageal closure: Please ad: …after earlier failure of primary anastomosis How is
the ICG infused into the distal pouch?
Thank you. I have added that. The ICG infused into the distal pouch through the tube from the
gastrostomy.
Please add this details to the text
ICG (0.5 ml) was infused into the upper and lower esophageal pouches with the tube and via
the gastrostomy.
How much ICG was administered?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
Thank you. The rTEF of that patient was thin, and the patient just went through the surgery few
days ago. According to our experience, the patient needs to be treated conservatively instead of
operation immediately. Some of them (though few) will self-healing. In another three months,
we will evaluate the patient if he had the surgery indication,
Please ad: initially and delete: and temporarily
In addition, the case of recurrent TEF was initially treated conservatively.
Discussion
ICG skin tests were performed because the agent contained iodine… Please describe the test in
the Materials and Methods section
Thank you. I have added this part.
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
Thank you. We had mentioned this part at the end of the Materials and Methods section. I revised
the sentence to illustrate clearly.
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
In our experience, we thought that the ICG can be a good indicator and the guidewire should
be abandoned.
Can you ad this into the conclusion:
that may eliminating the need for guide wire placement
to treat complications after esophageal atresia repair is a safe and reliable method that may
eliminating the need for guide wire placement and therefore deserves promotion.
Ref 5: undefined? Should be (9)… Ref 13: please delete ref 9…..
I’m sorry about that mistake. I have revised.
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture? Thank you, I
had flipped.
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
Thank you, I revised the illustration under the figure.
Much better, please change fistulae into fistula… there is only one fistula
Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 4 Date: 14 Jul 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
Thank you. Sure, you are right. In this article, I mean the case was fail to anastomose the
esophageal pouches after attempts, which was the unintended results. That was so complicated
to revision surgery. I have modified the text.
Please change delayed primary closure into failed primary anastomosis……
The common condition requiring surgical repair include recurrent tracheoesophageal fistula
(rTEF), which occurs in up to 5%-14% of patients,1,2 and failed primary anastomosis.
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?
Thank you. 0.625mg ICG (0.5 ml, concentration 1.25 mg/ml) diluted with sterile water was
infused into the devices tube of bronchoscope by the syringe. And then 5-10ml air was infused
after that to sprayed the ICG to the fistulae.
Can you include the whole text in the document? I think these details can help other centers to
apply your method.
What tissue was used to create two separate layers of pedicle flaps? Thank you. They are
mediastinal connective tissue or lymph nodes nearby.
Please add these details to the text
Delayed esophageal closure: Please ad: …after earlier failure of primary anastomosis How is
the ICG infused into the distal pouch?
Thank you. I have added that. The ICG infused into the distal pouch through the tube from the
gastrostomy.
Please add this details to the text
ICG (0.5 ml) was infused into the upper and lower esophageal pouches with the tube and via
the gastrostomy.
How much ICG was administered?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
Thank you. The rTEF of that patient was thin, and the patient just went through the surgery few
days ago. According to our experience, the patient needs to be treated conservatively instead of
operation immediately. Some of them (though few) will self-healing. In another three months,
we will evaluate the patient if he had the surgery indication,
Please ad: initially and delete: and temporarily
In addition, the case of recurrent TEF was initially treated conservatively.
Discussion
ICG skin tests were performed because the agent contained iodine… Please describe the test in
the Materials and Methods section
Thank you. I have added this part.
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
Thank you. We had mentioned this part at the end of the Materials and Methods section. I revised
the sentence to illustrate clearly.
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
In our experience, we thought that the ICG can be a good indicator and the guidewire should
be abandoned.
Can you ad this into the conclusion:
that may eliminating the need for guide wire placement
to treat complications after esophageal atresia repair is a safe and reliable method that may
eliminating the need for guide wire placement and therefore deserves promotion.
Ref 5: undefined? Should be (9)… Ref 13: please delete ref 9…..
I’m sorry about that mistake. I have revised.
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture? Thank you, I
had flipped.
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
Thank you, I revised the illustration under the figure.
Much better, please change fistulae into fistula… there is only one fistula
Please review this paper.
user
Title: Indocyanine green fluorescence imaging localization-assisted thoracoscopy revision
surgery after repair of esophageal atresia
Version: 4 Date: 14 Jul 2022
Reviewer:  Stefaan H. A. J. Tytgat
Reviewer's report:
Background:
I don’t think that delayed primary closure should be considered a complication of EA repair
Thank you. Sure, you are right. In this article, I mean the case was fail to anastomose the
esophageal pouches after attempts, which was the unintended results. That was so complicated
to revision surgery. I have modified the text.
Please change delayed primary closure into failed primary anastomosis……
The common condition requiring surgical repair include recurrent tracheoesophageal fistula
(rTEF), which occurs in up to 5%-14% of patients,1,2 and failed primary anastomosis.
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?
Thank you. 0.625mg ICG (0.5 ml, concentration 1.25 mg/ml) diluted with sterile water was
infused into the devices tube of bronchoscope by the syringe. And then 5-10ml air was infused
after that to sprayed the ICG to the fistulae.
Can you include the whole text in the document? I think these details can help other centers to
apply your method.
What tissue was used to create two separate layers of pedicle flaps? Thank you. They are
mediastinal connective tissue or lymph nodes nearby.
Please add these details to the text
Delayed esophageal closure: Please ad: …after earlier failure of primary anastomosis How is
the ICG infused into the distal pouch?
Thank you. I have added that. The ICG infused into the distal pouch through the tube from the
gastrostomy.
Please add this details to the text
ICG (0.5 ml) was infused into the upper and lower esophageal pouches with the tube and via
the gastrostomy.
How much ICG was administered?
One patient with a recurrence of the rTEF was treated conservatively and temporarily….. please
explain?
Thank you. The rTEF of that patient was thin, and the patient just went through the surgery few
days ago. According to our experience, the patient needs to be treated conservatively instead of
operation immediately. Some of them (though few) will self-healing. In another three months,
we will evaluate the patient if he had the surgery indication,
Please ad: initially and delete: and temporarily
In addition, the case of recurrent TEF was initially treated conservatively.
Discussion
ICG skin tests were performed because the agent contained iodine… Please describe the test in
the Materials and Methods section
Thank you. I have added this part.
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
Thank you. We had mentioned this part at the end of the Materials and Methods section. I revised
the sentence to illustrate clearly.
Do the authors advocate the use of a guidewire for identification of the rTEF? Or should this
extra procedure be abandoned?
In our experience, we thought that the ICG can be a good indicator and the guidewire should
be abandoned.
Can you ad this into the conclusion:
that may eliminating the need for guide wire placement
to treat complications after esophageal atresia repair is a safe and reliable method that may
eliminating the need for guide wire placement and therefore deserves promotion.
Ref 5: undefined? Should be (9)… Ref 13: please delete ref 9…..
I’m sorry about that mistake. I have revised.
Figures:
Figure 1
Can you flip the images, with the posterior wall at the lower end of the picture? Thank you, I
had flipped.
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
Thank you, I revised the illustration under the figure.
Much better, please change fistulae into fistula… there is only one fistula
assistant