Management of Postoperative Left-Sided Chylothorax Using Indocyanine Green Fluorescence-Guided VATS

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, 

Thank you for the opportunity to review this interesting case report on the surgical management of chylothorax using indocyanine green. 

I congratulate the authors on their work, which has highlighted the usefulness and practicality of this technique in identifying the point of chylous leakage in 'non-standard' areas. 

I also congratulate them for including the video of the operation, which allows us to see the success and effectiveness of this approach. 

I have nothing to suggest. 

Author Response

Comment 1: Dear authors, Thank you for the opportunity to review this interesting case report on the surgical management of chylothorax using indocyanine green. I congratulate the authors on their work, which has highlighted the usefulness and practicality of this technique in identifying the point of chylous leakage in 'non-standard' areas. I also congratulate them for including the video of the operation, which allows us to see the success and effectiveness of this approach. I have nothing to suggest. 

Response 1: We kindly thank the Reviewer for their appreciation. We hope to collaborate with them in other occasions.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, First I congratulate you for your article. 

'The case report  article aims to summarize  the use of ICG fluorescence  during VATS to successfully identify and treat a left-sided chylothorax, emphasizing the efficacy of this technique in targeted, site-specific interventions. Also its impact on chylothorax treatment, and the future directions for the entity to assist surgeons when choosing the optimal surgical technique. I think this topic orginal and relavent with the field. 'Using Indocyanine Green Fluorescence-Guided VATS for chylothorax' adress a specific gap in the literature. Although there are similar studies on the subject, this study makes a comprehensive and well-prepared contribution to the field of chylothorax surgery. The discussion section  can be expanded with the support of current literature and discussing different methods that can be used. The conclusion is consistent with the findings of case presented. This section addresses the main issue raised. The references used in the article are adequate and up-to-date. The  figure and video link used are harmonious and sufficient to ensure the integrity of the subject. Also the authors should  include their own clinical experience with chylothorax surgery in the relevant sections of the article.'

Comments on the Quality of English Language

 Minor editing of English language required.

Author Response

Comment 1: Dear authors, First I congratulate you for your article. 'The case report  article aims to summarize  the use of ICG fluorescence  during VATS to successfully identify and treat a left-sided chylothorax, emphasizing the efficacy of this technique in targeted, site-specific interventions. Also its impact on chylothorax treatment, and the future directions for the entity to assist surgeons when choosing the optimal surgical technique. I think this topic orginal and relavent with the field. 'Using Indocyanine Green Fluorescence-Guided VATS for chylothorax' adress a specific gap in the literature. Although there are similar studies on the subject, this study makes a comprehensive and well-prepared contribution to the field of chylothorax surgery. The discussion section can be expanded with the support of current literature and discussing different methods that can be used. The conclusion is consistent with the findings of case presented. This section addresses the main issue raised. The references used in the article are adequate and up-to-date. The  figure and video link used are harmonious and sufficient to ensure the integrity of the subject. Also the authors should  include their own clinical experience with chylothorax surgery in the relevant sections of the article.'

Response 1: Thank you for the appreciation and for the precious comments. We implemented the manuscript with an entire paragraph in the discussion section about the recent literature available on the surgical chylothorax management. 

Reviewer 3 Report

Comments and Suggestions for Authors

Congratulations to you on your successful rescue of a patient who would possibly be dying from a fatal complication. The entire manuscript was well written except there are several unsuitable medical terms which should be revised before the consideration of publication.

(1)sealed with metal clips--> ligated with .... or closed up with

(2) endovenous--> intravenous

(3) ionic compensation---> electrolytes supply, electrolytes imbalance

(4) absence of air or chylous leakage

(5) dismissed---> discharged

(6) highlightened---> highlighted

(7) precise separation ---> precise division

Comments on the Quality of English Language

Some medical terms should be revised

Author Response

Comment 1: Congratulations to you on your successful rescue of a patient who would possibly be dying from a fatal complication. The entire manuscript was well written except there are several unsuitable medical terms which should be revised before the consideration of publication.

(1)sealed with metal clips--> ligated with .... or closed up with

(2) endovenous--> intravenous

(3) ionic compensation---> electrolytes supply, electrolytes imbalance

(4) absence of air or chylous leakage

(5) dismissed---> discharged

(6) highlightened---> highlighted

(7) precise separation ---> precise division

Response 1: We thank the Reviewer for the specifications. We proceeded to correct point by point in the manuscript all the terminology in order to provide a better comprehension of the medical terms. 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear author,

The revised article can be accepted.

Thank you,

Kind regards.

Reviewer 3 Report

Comments and Suggestions for Authors

You have already revised accordingly. The manuscript can be accepted for publication.