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Indocyanine green fluorescence-guided laparoscopic surgery, with omental appendices as fluorescent markers for colorectal cancer resection: a pilot study

Abstract

Background

Currently, we lack tools that can reliably guide laparoscopic surgeons to a target anatomical destination for dissection. We aimed to develop and evaluate a fluorescent destination marker (FDM), composed of a resected omental appendix injected with indocyanine green (ICG), for real-time navigation in laparoscopic surgery for colorectal cancer in this pilot study.

Methods

This study included ten patients diagnosed with colorectal cancer. To prepare FDMs, we laparoscopically harvested omental appendices attached to the colon we planned to resect. The harvested appendices were injected with diluted ICG, and a gauze tag was attached. The FDMs were placed at target intra-abdominal sites with a ligation clip.

Results

Patient diagnoses included 1 cecal, 2 ascending colon, 3 transverse colon, 2 sigmoid colon, and 2 rectal cancers. No conversion to open surgery was required and no intraoperative complications occurred. We created 12 sets of FDMs, which were placed at a total of 13 sites in abdominal cavities. FDM fluorescence was successfully detected in all cases. Furthermore, FDMs could be detected earlier than the gauze tags at 12 points, and they were detected at the same time at 1 point.

Conclusions

All FDMs facilitated laparoscopic surgery by allowing the surgeon to find the tissue to be dissected, particularly in procedures that required the dissection of lymph nodes around middle colic vessels and mobilization of the splenic flexure. FDMs showed potential for guiding the laparoscopic surgeon to a target anatomical destination. This marker represents a contribution to the evolution of real-time navigation surgery.

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Correspondence to Atsushi Hamabe.

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Disclosures

Atsushi Hamabe, Takayuki Ogino, Tsukasa Tanida, Shingo Noura, Shunji Morita, and Keizo Dono have no conflicts of interest or financial ties to disclosure.

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Supplementary material Video 2 (MP4 169978 KB)

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Cite this article

Hamabe, A., Ogino, T., Tanida, T. et al. Indocyanine green fluorescence-guided laparoscopic surgery, with omental appendices as fluorescent markers for colorectal cancer resection: a pilot study. Surg Endosc 33, 669–678 (2019). https://doi.org/10.1007/s00464-018-6504-6

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Keywords

  • Laparoscopic surgery
  • Navigation
  • Colorectal cancer
  • Indocyanine green