Purpose Chyle fistula post neck dissection is challenging complication associated with morbidity and mortality. Radiological management can be problematic and identification intraoperatively of the thoracic duct for ligation/preservation can be hampered by the anatomical variations and complexity. Methodology We describe the utilisation of Fluorescence-Guided Identification of the Thoracic Duct and ligation by VATS. A novel technique utilised in thoracic surgery to identify the thoracic duct with increased accuracy and minimise indirect trauma. This technique has been previously described in the management of chylothorax but not chyle fistula post neck dissection. Results A 65-year-old gentleman underwent bilateral radical neck dissection for recurrent metastatic papillary thyroid cancer. On day 2 post operatively, he developed a high output left neck drain draining over 2 litres of chyle. Radiological guided embolization was attempted on day 6 and 7 but failed due to patient instability and inability to cannulate the thoracic duct, respectively. Conservative management was attempted with TPN however drain output remained high. On Day 10 the patient underwent a VATS procedure with pre-operative subcutaneous injection of Indocyanine green. Intra-operatively the thoracic duct was visualised using fluorescence imaging and clipped proximally and distally with cessation of flow confirmed. Post-operatively the chyle fistula resolved and the neck drain was removed on day 2. Conclusion This case highlights the difficulty associated with chyle fistula management post neck surgery as well as the utility of near-infrared indocyanine green fluorescence lymphography with VATS thoracic duct ligation as a safe and effective management option