Indocyanine green injection for detecting sentinel nodes using color fluorescence camera in the laparoscopy‐assisted gastrectomy

Abstract

Background and Aim: We seek for the accurate and simple method for detecting sentinel nodes of gastric cancer which can be popularized in community hospitals. The indocyanine green (ICG) fluorescence-guided method is reported to be sensitive. However, the ordinal fluorescence cameras have gray scale imaging and require a dark room. We have developed a new device, Hyper Eye Medical System (HEMS) which can simultaneously detect color and near-infrared rays and can be used under room light. This study was planned to examine whether submucosal injection of 0.5 mL ¥ 4 of 50 mg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery. Methods: The patients underwent gastrectomy for clinical T1a (mucosa)-T2 (muscularis propria) and clinical N0 were enrolled in the present study. As a preliminary trial, one case each of the ICG 25 and 100 mg/mL, injected on the day before operation and intraoperative injection, was examined. Then, 10 cases injected 50 mg/mL ICG on the day before operation were examined. Results: The ICG fluorescence of the patient injected 100 mg/mL was too intense and that of the patient injected 25 mg/mL was too faint. Sentinel lymph nodes were detected in all of 10 cases injected 50 mg/mL, the day before operation and number of sentinel lymph nodes per patient was 3.6 Ϯ 2.1. Metastasis was observed in one case. All of ICG fluorescence-positive sentinel nodes were positive for the metastasis. In the patient who underwent intraoperative injection, sentinel lymphatic basins could be identified. Conclusion:The present study shows that HEMS-guided abdominal surgery is feasible under room light. Submucosal injection of 0.5 mL ¥ 4 of 50 mg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery.

Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System

“…The bright‐field/color fluorescence camera of the HyperEye Medical System® (Mizuho, Tokyo, Japan) has been used in gastroenterological surgeries to visualize sentinel lymph nodes and blood flow 24, 25.…”

A new stage of sentinel node navigation surgery in early gastric cancer

“…But a dark field in an operating room is necessary for detecting SNs in SN mapping by the PDE. Newly developed ICG fluorescence systems such as the HyperEye Medical System (Mizuho Medical, Tokyo, Japan) [17] and the D-light P system (Karl Storz, Tuttlingen, Germany) ( Fig. 1) do not need room lights to be turned off for SN detection.…”

Evaluation of the novel near-infrared fluorescence tracers pullulan polymer nanogel and indocyanine green/γ-glutamic acid complex for sentinel lymph node navigation surgery in large animal models

“…The concentration of ICG commonly used in vital dye methods is too high for the NIR imaging system, because the rapid dispersion of ICG and high sensitivity of the NIR system showed too many lymph nodes [23,31]. We have developed three strategies to overcome the weaknesses of ICG using materials that are possibly much less harmful than quantum dots.…”

“…However, when ICG is used at the same concentration for visualization in gastric cancer, the problems of rapid and extensive dispersion persist in NIR imaging systems [23]. To overcome these disadvantages of ICG, we applied three strategies in the present study.…”