J Gastric Cancer.  2017 Jun;17(2):145-153. 10.5230/jgc.2017.17.e17.

Real-time Vessel Navigation Using Indocyanine Green Fluorescence during Robotic or Laparoscopic Gastrectomy for Gastric Cancer

• Kim M
• Son SY
• Cui LH
• Shin HJ
• Hur H
• Han SU

• KMID: 2383737
• DOI: http://doi.org/10.5230/jgc.2017.17.e17

Abstract

PURPOSE
Identification of the infrapyloric artery (IPA) type is a key component of pylorus-preserving gastrectomy. As the indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels and flow during reconstruction, we speculated that this emerging technique would be helpful in identifying the IPA type.
MATERIALS AND METHODS
From August 2015 to February 2016, 20 patients who underwent robotic or laparoscopic gastrectomy were prospectively enrolled. After intravenous injection of approximately 3 mL of ICG (2.5 mg/mL), a near-infrared fluorescence apparatus was applied. The identified shape of the IPA was confirmed by examining the actual anatomy following infrapyloric dissection.
RESULTS
The mean interval time between ICG injection and visualization of the artery was 22.2 seconds (range, 14-30 seconds), and the mean duration of the arterial phase was 16.1 seconds (range, 9-30 seconds). The overall positive predictive value (PPV) of ICG fluorescence in identifying the IPA type was 80% (16/20). The IPA type was incorrectly predicted in four patients, all of whom were obese with a body mass index (BMI) of more than 25 kg/m².
CONCLUSIONS
Our preliminary results indicate that intraoperative vascular imaging using the ICG fluorescence technique may be helpful for robotic or laparoscopic pylorus-preserving gastrectomy.

Keyword

Stomach neoplasms; Laparoscopy; Indocyanine green; Fluorescence

MeSH Terms

Arteries
Blood Vessels
Body Mass Index
Fluorescence*
Gastrectomy*
Humans
Indocyanine Green*
Injections, Intravenous
Laparoscopy
Prospective Studies
Stomach Neoplasms*
Indocyanine Green

Figure

• 

  Fig. 1 ICG fluorescence images of various IPA types and an accessory splenic artery. (A) In the distal type, 2 separated fluorescent streams (blue arrows) arise from the pancreas head. (B) In the caudal type, a stream is divided into 2 (blue arrows) at the RGEA. (C) In the proximal type, the duodenum is slightly visualized without any vessel visualization, and then the RGEA is solely visualized (blue arrow). IPA = infrapyloric artery; RGEA = right gastroepiploic artery; GDA = gastroduodenal artery; ASPDA = anterior superior pancreaticoduodenal artery; ICG = indocyanine green.

• 

  Fig. 2 An accessory splenic artery (blue arrows) from the LGEA. LGEA = left gastroepiploic artery.

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