Indocyanine green imaging to guide lymphadenectomy in laparoscopic distal gastrectomy - With vídeo. (September 2021)

• Record Type: Journal Article
• Authors: Sakamoto, Erica; Kodama Pertille Ramos, Marcus Fernando; Dias, Andre Roncon; Safatle-Ribeiro, Adriana Vaz; Zilberstein, Bruno; Nahas, Sergio Carlos; Junior, Ulysses Ribeiro
• Is Part Of: Annals of medicine and surgery. Volume 69(2021)
• Publication Date: 2021-09
• Subjects: Stomach neoplasms -- Indocyanine green -- Laparoscopy -- Gastrectomy -- Lymph node excision; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102657
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Gastric cancer (GC) is one of the most lethal malignancies and Gastrectomy with D2 lymphadenectomy is considered the standard surgical treatment. Adequate lymph node dissection is necessary for patients' prognosis, but D2 lymphadenectomy is technically demanding due to the complexity of anatomy, even more so if performed laparoscopically. The learning curve requires a high degree of training with a considerable number of cases and standardization of the technique. Recently, Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence Imaging have been presented as promising image-guided surgery techniques, providing real-time anatomy assessment and intra-operative visualization of blood flow, lymph nodes and lymphatic vessels. ICG fluorescence imaging has been studied in GC surgery, especially for real-time lymphatic mapping. At present, we are conducting a prospective, open-label, single-arm clinical trial (Clinical trial - NCT03021200) to evaluate the feasibility and outcomes of ICG and NIR Fluorescence Imaging in GC surgery. In this technical note, we present one approach to the use of this technique to guide lymphadenectomy in laparoscopic distal gastrectomy. Highlights: Lymph node status is one of the main prognostic factors in Gastric Cancer. The learning curve to an adequate laparoscopic D2 lymphadenectomy is challenging. ICG fluorescence imaging provides real-time lymphatic mapping in Gastric Cancer surgery being a useful tool to guide lymphadenectomy in laparoscopic gastrectomy.