Tracer-Guided Lymphadenectomy During Laparoscopic Radical Gastrectomy for Stomach Cancer

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07/14/23

Radical lymphadenectomy can improve tumor staging accuracy and long-term survival of patients with gastric cancer. The procedure is typically performed by eye and depends on a surgeon’s experience. Indocyanine green (ICG) near-infrared (NIR) fluorescent imaging has improved sentinel lymph node localization in other cancers and has been incorporated into laparoscopic device technology. This procedure video illustrates ICG tracer-guided suprapancreatic lymph node dissection for gastric cancer using a left approach under natural light and NIR imaging in 3 modes of illumination: infrared (lymph nodes fluoresce white), green fluorescence (lymph nodes fluoresce green), and blue or color segmented fluorescence (proprietary processing software maps relative fluorescence brightness to a contrasting color scale overlaid; increasing fluorescence levels transition from blue to yellow to red). The steps of the procedure are:

00:10: The pancreatic capsule is peeled up to the superior border, the hepatopancreatic fold is opened, and the initial segment of the splenic artery is separated and exposed up to its root.

00:41: The left gastric vein is separated, exposed, vascularized, and divided at its root between clips. The left gastric artery is denuded and divided, and lymph node stations 7 and 9 lymph nodes are excised.

01:11: The fatty lymphatic tissue in front of the common hepatic artery is dissected, and station 8a lymph nodes are completely removed. 01:56: Number 12a lymph nodes are dissected.

Click https://ja.ma/2VlYnRr for a video illustrating the preoperative injection of ICG tracer

Click https://ja.ma/2PoSO18 for a video of residual lymph node-bearing soft tissue dissection after laparoscopic radical gastrectomy and general lymph node dissection in a patient with gastric cancer,

Click https://ja.ma/2I0Glw9 for a video of in vitro lymph node retrieval under direct NIR imaging.

Click https://ja.ma/2vfIAsU for a complete discussion of the procedure and the findings from a trial comparing it with non-ICG tracer-guided lymph node dissection.