Robotic Total Gastrectomy with lymph node dissection guided by indocyanine green fluorescence imaging
February 9, 2017
Lymphadenectomy for gastric cancer is considered to be technically difficult to perform in conventional laparoscopic surgery. The robotic system has been introduced to overcome some of these technical limitations. Moreover the da Vinci robotic platform allows near-infrared fluorescence imaging (NIFI) with indocyanine green (ICG) to be integrated into the surgical field. A 0,2% ICG solution was injected into the submucosa endoscopically (1 to 2 days before operation) at four sites around the tumor. Lymph nodes which had taken up ICG appeared as green spots emitting clear fluorescence and were both dissected out intraoperatively and isolated in the dissected specimen with the help of the robotic camera. Our conviction in that NIFI with ICG may provide a valuable adjunct for overall lymph node retrieval.