Safe and Accurate Laparoscopic Total Gastrectomy for Remnant Gastric Cancer With Severe Adhesions Using Indocyanine Green Fluorescence Imaging: Guidance in Detection of the Accurate Dissection Layer to Avoid Organ Injury

Laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) requires advanced techniques due to severe postoperative adhesions and anatomic changes. We performed LTG in 2 patients with RGC using intraoperative indocyanine green (ICG) fluorescence imaging. Both cases previously underwent di...

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Bibliographic Details
Published in:The American surgeon 2024-06, Vol.90 (6), p.1794-1796
Main Authors: Yamazaki, Kimiyasu, Mochizuki, Kiyotaka, Date, Hiromi, Watanabe, Ryohei, Aoki, Takeshi
Format: Article
Language:English
Subjects:
Aged
Coloring Agents
Dissection - methods
Female
Gastrectomy - methods
Gastric Stump - diagnostic imaging
Gastric Stump - pathology
Gastric Stump - surgery
Humans
Indocyanine Green
Laparoscopy - methods
Liver - diagnostic imaging
Liver - pathology
Liver - surgery
Male
Middle Aged
Optical Imaging - methods
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Tissue Adhesions - diagnostic imaging
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Summary:Laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) requires advanced techniques due to severe postoperative adhesions and anatomic changes. We performed LTG in 2 patients with RGC using intraoperative indocyanine green (ICG) fluorescence imaging. Both cases previously underwent distal gastrectomy with Billroth-I reconstruction for gastric cancer and were subsequently diagnosed with early-stage gastric cancer of the remnant stomach. Indocyanine green (2.5 mg/body) was administered intravenously during surgery. The liver and common bile duct were clearly visualized during surgery using near-infrared fluorescence laparoscopy, and the adhesions between the hepatobiliary organs and remnant stomach were safely dissected. Laparoscopic total gastrectomy was successfully performed without complications, and the postoperative course was uneventful in both cases. Intraoperative real-time ICG fluorescence imaging allows clear visualization of the liver and common bile duct and can be useful in LTG for RGC with severe adhesions.
ISSN:0003-1348
1555-9823
DOI:10.1177/00031348241241720