Techniques in Coloproctology

, Volume 21, Issue 9, pp 757–760 | Cite as

Using fluorescence lymphangiography to define the ileocolic mesentery: proof of concept for the watershed area using real-time imaging

  • D. S. Keller
  • H. M. Joshi
  • M. Rodriguez-Justo
  • D. Walsh
  • J. C. Coffey
  • M. ChandEmail author
Technical Note


Recent advances in mesenteric science have demonstrated that the mesentery is a continuous structure with a ‘watershed’ area at the mesenteric apex between the right colon and terminal ileum, where lymphatic flow can proceed either proximally or distally. With this new understanding of the anatomy, functional features are emerging, which can have an impact on surgical management. Fluorescence lymphangiography or lymphoscintigraphy with indocyanine green allows real-time visualization of lymphatic channels, which highlights sentinel lymph nodes and may facilitate identification of the ideal margins for mesenteric lymphadenectomy during bowel resection for colon cancer. By using this novel technology, it is possible to demonstrate a watershed area in the ileocolic region and may facilitate more precise mesenteric dissection. In the present study, we provide proof of concept for the ileocolic watershed area using fluorescence lymphangiography.


Ileocolic Mesentery Watershed area Fluorescence lymphangiography Oncologic resection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Full compliance with ethical standards was performed through Joint Research Office approval at University College of London.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • D. S. Keller
    • 1
    • 2
    • 3
  • H. M. Joshi
    • 1
  • M. Rodriguez-Justo
    • 4
  • D. Walsh
    • 5
  • J. C. Coffey
    • 6
  • M. Chand
    • 1
    • 2
    Email author
  1. 1.Department of Surgery and Interventional SciencesUniversity College London HospitalsLondonUK
  2. 2.GENIE CentreUniversity College LondonLondonUK
  3. 3.Division of Colorectal Surgery, Department of SurgeryBaylor University Medical CenterDallasUSA
  4. 4.Department of HistopathologyUniversity College London HospitalLondonUK
  5. 5.Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical SchoolUniversity of LimerickLimerickIreland
  6. 6.Department of SurgeryUniversity Hospital LimerickLimerickIreland

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