Jose Noguera*, Laura Castro, Lourdes Garcia, Cristina Mosquera and Alba Gomez
Department of Surgery, Complejo Hospitalario Universitario A Coruna, SpainFulltext PDF
Background: The Indocyanine Green (ICG) lymphography has the advantage of offering a good visualization of the lymphatic channels but there are problems in order to identify the lymphatic nodes. Intraoperative fluorescence ICG navigation also aims for detection of aberrant lymphatic drainage outside of the planned resection. Our objective with this study is to rate the use of the intraoperative lymphogram in cases of elective colorectal surgery to evaluate if there were changes in the surgical attitude regarding the performance of lymphadenectomy.Methods: Indocyanine green was injected into the submucosal layer around the tumor at 2 points (2 cm proximal and distal from the tumor) with a 23-gauge localized injection before lymph node dissection and the lymph flow was observed using a near-infrared camera system observed after 1,3 and 5 minutes after injection. A complete mesocolic excision with central vascular ligation was performed in all cases and an additional lymphadenectomy was realized including the region where the lymph flow was fluorescently observed.Results: The application of ICG was carried out in 10 selected patients with cT3-N0 colon cancer. In brief, it was observed that 20% of patients obtained additional lymph nodes after the expansion of the surgical plan; moreover in 10% affected lymph nodes were spotted after the expansion of the surgical plan.Conclusion: Intraoperative real-time visualization of the lymph flow using indocyanine green fluorescence imaging during laparoscopic colon cancer surgery is feasible and a helpful technique for lymph node mapping which may lead to intraoperative changes in lymphadenectomy. Further studies with prospective clinical series will be necessary to know the role of this technique in colorectal cancer.
Fluorescence; Colorectal cancer; Lymphadenectomy; Indocyanine green; Laparoscopy
Noguera J, Castro L, Garcia L, Mosquera C, Gomez A. Lymphadenectomy Guided by Indocyanine-Green (ICG) in Colorectal Cancer: A Pilot Study. J Surg Tech Proced. 2019; 3(1): 1023.