Purpose: Chylothorax results from an injury to the thoracic duct or its tributaries. This may be postsurgical, traumatic, inflammatory or malignant. A chyle leak is a very challenging problem to manage and can result in prolonged length of stay and often requires surgical correction. At Royal North Shore Hospital we have developed a strategy for chyle leak prevention in major thoracic resections and its management when it occurs. These techniques can reduce the morbidity of this condition and improve patient outcomes. Methods: Management and prevention of chylothorax requires a multi-disciplinary team, primarily involving surgeons and interventional radiologists. Chyle leaks can be treated with a several techniques including diet modification, embolization, sclerosing agents, ligation of the thoracic duct and pleurodesis. The use of indocyanine green and near infra-red thoracoscopy offers an accurate method of identification of the thoracic duct during surgery and the identification of a chyle leak when it has occurred. This new technology is a useful adjunct to managing this challenging condition. Results: Patients considered to be at high risk of thoracic duct injury are pre-operatively injected with indocyanine green into the inguinal lymph nodes to identify the thoracic duct and any chyle leak at the time of primary surgery. Injection of indocyanine green provides an accurate way to identify the thoracic duct during surgery. In patients with an active chyle leak, indocyanine green injection into the inguinal lymph nodes helps to identify the leak source and avoids the risks of aspiration following cream ingestion prior to induction. For low volume chyle leaks patients lipiodol injection has proved useful as a sclerosing agent and identification of the level of leak. Conclusions: Indocyanine green has proven to be a useful tool in the management of chyle leaks.