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Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy

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Abstract

Purpose

We aimed to investigate the usefulness of near-infrared indocyanine green (ICG)-enhanced fluorescence guidance for infrapyloric LN dissection in laparoscopic distal gastrectomy.

Methods

This study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1 mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG injection.

Results

The mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than in the non-ICG group (n = 60) (13.05 ± 5.77 vs 18.68 ± 7.92 min; p = 0.001), and the incidence of bleeding during infrapyloric LN dissection was lower in the ICG group (20% vs 68.3%, p < 0.001). The two groups did not differ significantly regarding the number of LNs retrieved from the infrapyloric area (p = 0.434).

Conclusions

Near-infrared ICG fluorescence guidance facilitates safe and fast infrapyloric LN dissection in laparoscopic distal gastrectomy.

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Acknowledgements

None.

Funding

This study was partly supported by Novadaq® Inc. (incorporated to Stryker Inc.). The funder had no role in study design, data analysis, or writing of this article.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea

    Shin-Hoo Park, Felix Berlth, Jong-Ho Choi, Ji-Hyeon Park, Yun-Suhk Suh, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee & Han-Kwang Yang

  2. Department of General, Visceral and Transplant Surgery, Medical Center of the Johannes Gutenberg University, Mainz, Germany

    Felix Berlth

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Hyuk-Joon Lee & Han-Kwang Yang

Authors
  1. Shin-Hoo Park
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Contributions

S-HP, J-HC, Y-SS, S-HK, DJP, H-KY: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. S-HP, FB, J-HC, J-HP, Y-SS, S-HK, DJP, H-KY: Drafting the work or revising it critically for important intellectual content. S-HP, S-HK, H-JL, H-KY: Final approval of the version to be published. S-HP, FB, J-HC, J-HP, Y-SS, S-HK, DJP, H-JL, H-KY S-HP, FB, J-HC, J-HP, Y-SS, S-HK, DJP, H-JL, H-KY: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Han-Kwang Yang.

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The authors have no competing interests to declare in relation to this paper. The authors have full control of all primary data and agree to allow the journal to review our data, if requested.

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Electronic supplementary material

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Supplementary file1 Online Resource 1 Near-infrared fluorescence guidance using indocyanine green during infrapyloric lymph node dissection in laparoscopic distal gastrectomy for early gastric cancer (MPG 68474 kb)

595_2020_1993_MOESM2_ESM.docx

Supplementary file2 Online Resource 2 Percentage of patients with ICG fluorescence uptake at each LN station. ICG indocyanine green, LN lymph node. Online Resource 3 Time for ICG injection (minutes) over chronological cases (DOCX 342 kb)

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Park, SH., Berlth, F., Choi, JH. et al. Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy. Surg Today 50, 1187–1196 (2020). https://doi.org/10.1007/s00595-020-01993-w

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  • DOI: https://doi.org/10.1007/s00595-020-01993-w

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