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Laparoscopic detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging

Surgical Endoscopy volume 25, pages 1672–1676 (2011)Cite this article

Abstract

Background

Indocyanine green (ICG) fluorescence imaging is a promising technique for detection of sentinel node (SN) as it avoids unnecessary resection. However, the ICG fluorescence imaging system cannot be used in laparoscopic surgery because of technological difficulties.

Methods

A prototype laparoscopic detection system comprising an electron multiplier charge-coupled device (EM-CCD) as the detector and a xenon lamp as the light source was developed. The CCD camera head was attached to the end of a specially designed laparoscope that could transmit ICG fluorescence. The system allows visualization of both color and fluorescence images. Laparoscopic surgery in ten patients with gastric cancer included SN biopsy using ICG dye, ICG fluorescence images using our system, and laparoscopy-assisted gastrectomy (LAG) with lymphadenectomy. SNs were sliced into 2-mm sections for histological examination and imprint cytology.

Results

Immediately after intraoperative ICG injection by endoscopy, the laparoscopic ICG fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and traced the moving injected dye, whereas lymph vessels and nodes were hardly recognized by ICG green color through a standard laparoscope. Surgeons could confirm the removed lymph nodes stained with ICG by fluorescent imaging. SNs were successfully detected in all patients. Three patients had suspicious metastases in the SNs; two patients had lymph node metastases only in the SNs.

Conclusions

Our newly developed laparoscopic ICG fluorescence imaging system is promising in the detection of SNs in laparoscopic gastric cancer surgery. The preliminary results suggest an easier and shorter learning curve of dye-guided SN biopsy in laparoscopic gastric surgery.

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Acknowledgments

The authors thank Mr. Mitsuharu Miwa for the excellent technical support. This study was supported in part by the Otsuka Grant.

Disclosures

Drs. Miyashiro, Kishi, Yano, Tanaka, Motoori, Ohue, Ohigashi, Tomita, and Ishikawa, and Ms. Takenaka have no conflicts of interest or financial ties to disclose.

Author information

Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan

    Isao Miyashiro, Kentaro Kishi, Masahiko Yano, Koji Tanaka, Masaaki Motoori, Masayuki Ohue, Hiroaki Ohigashi & Osamu Ishikawa

  2. Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan

    Akemi Takenaka & Yasuhiko Tomita

Authors
  1. Isao Miyashiro
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  2. Kentaro Kishi
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  3. Masahiko Yano
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  4. Koji Tanaka
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  5. Masaaki Motoori
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  6. Masayuki Ohue
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  7. Hiroaki Ohigashi
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  8. Akemi Takenaka
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  9. Yasuhiko Tomita
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  10. Osamu Ishikawa
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Corresponding author

Correspondence to Isao Miyashiro.

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Miyashiro, I., Kishi, K., Yano, M. et al. Laparoscopic detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging. Surg Endosc 25, 1672–1676 (2011). https://doi.org/10.1007/s00464-010-1405-3

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  • DOI: https://doi.org/10.1007/s00464-010-1405-3

Keywords

  • Sentinel node
  • Gastric cancer
  • Indocyanine green fluorescence imaging
  • Laparoscopic surgery
  • Near-infrared light