Introduction: Chyle leak following injury to the Thoracic Duct (TD) is an uncommon but serious complication of cervicothoracic procedures including neck dissections and oesophagectomies, resulting in significant morbidity and mortality. Traditional methods including lymphangiography and lymphoscintigraphy are inherently limited. The objective of this study was to investigate the efficacy of Indocyanine Green Fluorescence (ICG) in facilitating TD visualisation and mitigating injury in cervicothoracic surgery. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Electronic databases were searched to identify randomised controlled trials, non-randomised controlled trials, and observational studies assessing ICG for TD visualisation in cervical and thoracic surgeries. The primary outcome was TD visualisation using ICG. Secondary outcomes included intra operative and post-operative chyle leak detection rates, visualisation rate in white light, and mean time from injection to visualisation. Results: Twelve studies enrolling 349 subjects met inclusion criteria. TD visualisation rate was 93% (standard error 0.013, P<0.001). Visualisation in white light was lower at 54.3% (standard error 0.065, P<0.001). Intra-operative chyle leak detection using ICG was higher compared to no ICG use: 74% (standard error 0.047, P<0.001) vs 17.5% (standard error 0.086, P=0.043). ICG use lowered post-operative chyle leak from 10.1% (standard error, P<0.001) to 3.9% (standard error 0.021, P=0.061), although odds ratio analysis showed negligible difference (OR 0.445, P=0.314). Mean time from ICG injection to TD visualisation was 83.94 minutes (P<0.001), shorter at 60.78 minutes with inguinal administration. Conclusions: ICG offers effective TD visualisation in cervicothoracic surgery, potentially reducing intra-operative complications and adverse sequelae from duct injury. Further high-quality randomised controlled trials are required.

Abdiqadir Omar Mohamed is an otolaryngology trainee based in the UK. He graduated from the University of Nottingham Medical School and holds a BSc in Audiology from University College London. He has a special interest in head and neck surgery and continues to actively engage in clinical research, with recent work focused on improving surgical outcomes through innovative technologies such as indocyanine green fluorescence imaging.