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Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy

Authors
  • Park, Shin-Hoo1
  • Berlth, Felix1, 2
  • Choi, Jong-Ho1
  • Park, Ji-Hyeon1
  • Suh, Yun-Suhk1
  • Kong, Seong-Ho1
  • Park, Do Joong1
  • Lee, Hyuk-Joon1, 3
  • Yang, Han-Kwang1, 3
  • 1 Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea , Seoul (South Korea)
  • 2 Medical Center of the Johannes Gutenberg University, Mainz, Germany , Mainz (Germany)
  • 3 Seoul National University College of Medicine, Seoul, Korea , Seoul (South Korea)
Type
Published Article
Journal
Surgery Today
Publisher
Springer Singapore
Publication Date
Apr 03, 2020
Volume
50
Issue
10
Pages
1187–1196
Identifiers
DOI: 10.1007/s00595-020-01993-w
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeWe aimed to investigate the usefulness of near-infrared indocyanine green (ICG)-enhanced fluorescence guidance for infrapyloric LN dissection in laparoscopic distal gastrectomy.MethodsThis study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1 mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG injection.ResultsThe mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than in the non-ICG group (n = 60) (13.05 ± 5.77 vs 18.68 ± 7.92 min; p = 0.001), and the incidence of bleeding during infrapyloric LN dissection was lower in the ICG group (20% vs 68.3%, p < 0.001). The two groups did not differ significantly regarding the number of LNs retrieved from the infrapyloric area (p = 0.434).ConclusionsNear-infrared ICG fluorescence guidance facilitates safe and fast infrapyloric LN dissection in laparoscopic distal gastrectomy.

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