Surgical Endoscopy

, Volume 33, Issue 2, pp 620–632 | Cite as

Fluorescence lymphangiography-guided full-thickness oncologic gastric resection

  • Seong-Ho Kong
  • Francesco Marchegiani
  • Renato Soares
  • Yu-yin Liu
  • Yun-Suhk Suh
  • Hyuk-Joon Lee
  • Bernard Dallemagne
  • Han-Kwang Yang
  • Jacques Marescaux
  • Michele DianaEmail author
Dynamic Manuscript



We aimed to assess the feasibility of a novel hybrid endoscopic/laparoscopic non-exposed, full-thickness, single-wall gastric resection technique guided by a fluorescence lymphangiography to identify the lymphatic pathway and the sentinel node basin.


Eight large white pigs (4 acute and 4 survival models) were included. Indocyanine green was injected submucosally around a pseudo-tumor at four points (1 ml, 0.1 mg/ml). The lymphatic spreading pathway was identified by the means of near-infrared (NIR) laparoscopic camera, and the resection line was planned outside of the fluorescent signals, to include all the potential lymphatic channels. Lymph node (LN) dissection was performed at greater curvature side and the infrapyloric area preserving the infragastric artery for all pigs. At the lesser curvature, 3–4 branches of the gastric artery were preserved in all acute and in two survival (group A), while in the remaining animals, 1–2 branches were preserved (group B). Perfusion of the remaining stomach was examined by NIR angiography. The gastric motility and function were evaluated by the means of a dynamic MRI immediately after the procedure and repeated after 1 week in surviving animals.


The hybrid full-thickness resection with bilateral sentinel LN basin dissection were successfully performed with no intra-operative or post-operative complications. The removed specimen was including all the area with florescent signal. The remaining stomach demonstrated a good perfusion at the NIR angiography. The dynamic MRI revealed a preserved emptying function in the acute animals and in the group A, and a loss of function in the group B.


Fluorescence-lymphangiography guided hybrid resection was feasible to remove a relatively large part of the stomach including the lymphatic spreading pathway and sentinel basin. The extent of dissection in the lesser curvature side can affect the post-operative function and further researches are warranted to optimize the concept.


Near-infrared fluorescence guided surgery Full-thickness resection Sentinel node navigation surgery Image guided surgery Dynamic MRI Capillary lactate test 



This study was supported by an IHU-Strasbourg feasibility Grant (PI: Pr. Seong-Ho Kong) and by the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) project grant. Michele Diana is the recipient of the ELIOS project grant from the ARC foundation for Cancer Research, aiming at the development of fluorescence-guided surgery.

Compliance with ethical standards


Jacques Marescaux is the President of both IRCAD and IHU-Strasbourg Institutes, which are partly funded by Karl Storz, Medtronic and Siemens. Authors Seong-Ho Kong, Francesco Marchegiani, Renato Soares, Yu-Yin Liu, Yun-Suhk Suh, Hyuk-Joon Lee, Dallemagne B, Han-Kwang Yang and Michele Diana have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 90526 KB)

Supplementary material 2 (WMV 19442 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Seong-Ho Kong
    • 1
    • 2
  • Francesco Marchegiani
    • 1
  • Renato Soares
    • 1
  • Yu-yin Liu
    • 3
    • 4
  • Yun-Suhk Suh
    • 2
  • Hyuk-Joon Lee
    • 2
    • 5
  • Bernard Dallemagne
    • 3
  • Han-Kwang Yang
    • 2
    • 5
  • Jacques Marescaux
    • 1
    • 3
  • Michele Diana
    • 1
    • 3
    Email author
  1. 1.IHU Strasbourg, Institute of Image-Guided SurgeryStrasbourgFrance
  2. 2.Department of SurgerySeoul National University HospitalSeoulSouth Korea
  3. 3.IRCAD, Research Institute against Cancer of the Digestive SystemStrasbourgFrance
  4. 4.Department of General SurgeryChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
  5. 5.Cancer Research InstituteSeoul National University HospitalSeoulSouth Korea

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