Annals of Surgical Oncology

, Volume 23, Supplement 2, pp 266–274 | Cite as

Visualization of Lymph/Blood Flow in Laparoscopic Colorectal Cancer Surgery by ICG Fluorescence Imaging (Lap-IGFI)

  • Naoto Nishigori
  • Fumikazu Koyama
  • Tadashi Nakagawa
  • Shinji Nakamura
  • Takeshi Ueda
  • Takashi Inoue
  • Keijirou Kawasaki
  • Shinsaku Obara
  • Takayuki Nakamoto
  • Hisao Fujii
  • Yoshiyuki Nakajima
Colorectal Cancer



In laparoscopic colorectal cancer (Lap-CRC) surgery, determination of a suitable mesentery division line and the appropriate degree of lymphadenectomy by tracing the blood supply is critical. We performed visualization of the lymph and blood flow by laparoscopic indocyanine green (ICG) fluorescence imaging (Lap-IGFI).


ICG is injected into the submucosa near the tumor via colonoscopy, and the lymph flow is observed. Intestinal blood flow is evaluated by administering ICG intravenously.


For lymph flow, visualization of the main lymph node basin helped to determine the surgical division line for cases in which the blood flow was not completely visualized. Lap-IGFI changed the surgical plan of the lymphadenectomy in 23.5 %. In our experience, the metastatic rate of ICG-positive nodes was 10.0 %, and the metastatic rate of ICG-negative nodes was 5.3 %. Furthermore, there were no metastatic nodes that were ICG negative more than 5 cm from the tumor. For blood flow, the blood flow distribution of the intestinal wall from the last branch of the vasa recta of the anastomotic site was clearly visualized and proved useful in choosing the extent of intestinal resection. Lap-IGFI changed the surgical plan of the extensive intestinal resection in 16.7 %.


Lap-IGFI can noninvasively provide detailed lymph and blood flow information and is a useful device to aid in the accurate identification of individual patients’ lymph drainage. This helps dictate adequate lymphadenectomy and the extent of intestinal resection in Lap-CRC surgery.


Anastomotic Site Lymph Flow Intestinal Resection Japanese Guideline Blood Flow Distribution 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Naoto Nishigori
    • 1
  • Fumikazu Koyama
    • 1
  • Tadashi Nakagawa
    • 1
  • Shinji Nakamura
    • 1
  • Takeshi Ueda
    • 1
  • Takashi Inoue
    • 1
  • Keijirou Kawasaki
    • 1
  • Shinsaku Obara
    • 1
  • Takayuki Nakamoto
    • 1
  • Hisao Fujii
    • 2
  • Yoshiyuki Nakajima
    • 1
  1. 1.Department of SurgeryNara Medical UniversityNaraJapan
  2. 2.Department of Endoscopy and UltrasoundNara Medical UniversityNaraJapan

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