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Indocyanine green imaging to guide lymphadenectomy in laparoscopic distal gastrectomy - With video.

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.

SUBMITTER: Sakamoto E

PROVIDER: S-EPMC8361283 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Indocyanine green fluorescence imaging ensures perfusion of the remnant stomach during laparoscopic splenectomy in a patient after distal gastrectomy: A case report.

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Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer: long-term outcomes of a phase 3 randomised clinical trial.

Project description:Indocyanine green (ICG) fluorescence imaging-guided lymphadenectomy has been demonstrated to be effective in increasing the number of lymph nodes (LNs) retrieved in laparoscopic gastrectomy for gastric cancer (GC). Previously, we reported the primary outcomes and short-term secondary outcomes of a phase 3, open-label, randomized clinical trial (NCT03050879) investigating the use of ICG for image-guided lymphadenectomy in patients with potentially resectable GC. Patients were randomly (1:1 ratio) assigned to either the ICG or non-ICG group. The primary outcome was the number of LNs retrieved and has been reported. Here, we report the primary outcome and long-term secondary outcomes including three-year overall survival (OS), three-year disease-free survival (DFS), and recurrence patterns. The per-protocol analysis set population is used for all analyses (258 patients, ICG [n = 129] vs. non-ICG group [n = 129]). The mean total LNs retrieved in the ICG group significantly exceeds that in the non-ICG group (50.5 ± 15.9 vs 42.0 ± 10.3, P < 0.001). Both OS and DFS in the ICG group are significantly better than that in the non-ICG group (log-rank P = 0.015; log-rank P = 0.012, respectively). There is a difference in the overall recurrence rates between the ICG and non-ICG groups (17.8% vs 31.0%). Compared with conventional lymphadenectomy, ICG guided laparoscopic lymphadenectomy is safe and effective in prolonging survival among patients with resectable GC.

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Project description: Not available

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Hepatectomy guided by indocyanine green fluorescent imaging for visualizing bile leakage (with video).

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Identification of the Thoracic Duct Using Indocyanine Green During Cervical Lymphadenectomy.

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Rationally assembled albumin/indocyanine green nanocomplex for enhanced tumor imaging to guide photothermal therapy.

Project description:Herein, a novel phototheranostic nanocomplex that is self-assembled from bovine serum albumin (BSA) and indocyanine green (ICG) is developed for enhanced near-infrared (NIR) fluorescence imaging, which benefits the guidance on in vivo cancer photothermal therapy (PTT). The study confirms that the binding of ICG with the bind sits on the albumin will result in improved hydrolytic stability and high photoluminescence quantum yield (PLQY). The ICG loading ratio in the nanocomplex is optimized and confirms the loading ratio of 0.5% ICG to be the optimal content. The optimized ICG-BSA nanocomplex (ICG-BSA NC) possesses a higher PLQY of 16.8% than that of free ICG (2.7%). The high PLQY and efficient passive targeting ability of ICG-BSA NC help improve its in vivo tumor accumulation and NIR fluorescence imaging significantly. Under laser irradiation, efficient PTT with obvious tumor growth suppression on a triple negative breast tumor model can be observed in the ICG-BSA NC treated group.

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The oncologic safety and accuracy of indocyanine green fluorescent dye marking in securing the proximal resection margin during totally laparoscopic distal gastrectomy for gastric cancer: a retrospective comparative study.

Project description:BackgroundSecuring the proximal resection margin in totally laparoscopic distal gastrectomy for gastric cancer is related to curability and recurrence, while reducing the operation time is related to patient safety. This study aimed to investigate the role of indocyanine green (ICG) fluorescent dye marking in totally laparoscopic distal gastrectomy, whether it is an oncologically safe and accurate procedure that can be conducted in a single centre.MethodsThe data of 93 patients who underwent laparoscopic-assisted distal gastrectomy (non-ICG group) or totally laparoscopic distal gastrectomy using ICG (ICG group) between 2010 and 2020 were retrospectively reviewed. To correct for confounding factors, a propensity score matching was performed.ResultsProximal resection margin did not vary with the ICG injection site after the propensity score matching (lower ICG, 3.84 cm vs. lower non-ICG, 4.42 cm, p = 0.581; middle ICG, 3.34 cm vs. middle non-ICG, 3.20 cm; p = 0.917), while the operation time was reduced by a mean of 34 min in the ICG group (ICG, 239.3 [95% confidence interval, 220.1-258.5 min]; non-ICG, 273.0 [95% confidence interval, 261.6-284.4] min; p = 0.006).ConclusionsICG injection for securing the proximal resection margin in totally laparoscopic distal gastrectomy is an oncologically safe and accurate procedure, with the advantage of reducing the operation time of gastric cancer surgery while it has the benefit of locating the tumour or clips when it is impossible to locate the tumour during surgery due to the inability to perform an endoscopic examination or when it is hard to directly palpate the tumour or clips in the operating theatre; this can be performed at a single centre.

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Laparoscopic left hemihepatectomy guided by real-time indocyanine green fluorescence imaging using the arantius-first approach.

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| S-EPMC10481454 | biostudies-literature

Reduced-port laparoscopic distal gastrectomy in obese gastric cancer patients.

Project description:BackgroundReduced-port laparoscopic gastrectomy is currently widely performed for patients with gastric cancer. However, its safety in obese patients has not yet been verified. This is the first study on reduced-port laparoscopic distal gastrectomy (RpLDG) in obese patients with gastric cancer. This study aimed to evaluate the short-term surgical outcomes and investigate the feasibility and safety of RpLDG in obese patients with gastric carcinoma.Material and methodsA total of 271 gastric cancer patients who underwent RpLDG at our institution were divided into two groups: non-obese [body mass index (BMI) <30 kg/m2, n = 251; NOG] and obese (BMI ≥30 kg/m2, n = 20; OG). The mean age of the enrolled patients was 64.8 ± 11.4 years, with 72.0% being men and 28.0% women. Operative details and short-term surgical outcomes, including hospital course and postoperative complications, were compared by retrospectively reviewing the medical records.ResultsNo significant difference in operation time was found between the NOG and OG (205.9 ± 40.0 vs. 211.3 ± 37.3 minutes, P = 0.563). Other operative outcomes in the OG, including estimated blood loss (54.1 ± 86.1 vs. 54.0 ± 39.0 mL, P = 0.995) and retrieved lymph nodes (36.2 ± 16.4 vs. 35.5 ± 18.2, P = 0.875), were not inferior to those in the NOG. There were also no statistical differences in short-term surgical outcomes, including the incidence of surgical complications (13.9% vs. 10.0%, P = 1).ConclusionRpLDG can be performed safely in obese gastric cancer patients by an experienced surgeon. It should be considered a feasible alternative to conventional port distal gastrectomy.

| S-EPMC8341504 | biostudies-literature

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