Abstract:Intraoperative real-time visualization of the lymph flow using indocyanine green fluorescence imaging during laparoscopic colon cancer surgery, especially flexural colon cancer surgery, is feasible and a helpful technique for identifying appropriate central vessels to be dissected and for determining an appropriate separation line of the mesentery.
“…In the present study, we had visualisation of the lymphatic drainage in all patients. Earlier studies also described the safety, feasibility, and high success rate of ICG FI in this application [30,33,34]. In our sample, the lymphatic drainage was partially demonstrated in 3 patients, insufficient to guide the lymphadenectomy.…”
Section: Ten Consecutive Patients With a Diagnosis Of Colon Cancer Unsupporting
confidence: 48%
“…Prior work has supported the value of ICG FI to identify aberrant nodes [28,30,[35][36][37]. [22,26,29,30,33,34,[38][39][40][41]. We have previously reported our technique of subserosal injection to visualize lymphatic drainage in a colon cancer patient [12].…”
Section: Ten Consecutive Patients With a Diagnosis Of Colon Cancer Unmentioning
ICG can be safely injected into the peritumoural subserosal and demonstrate lymphatic drainage in colon cancer. This proof of concept and proposed standards for the procedure can lead to future studies to optimize the application of image-guided precision surgery in colon cancer. Furthermore, this technique may be of value in indicating the need for more extended lymphadenectomy.
“…In the present study, we had visualisation of the lymphatic drainage in all patients. Earlier studies also described the safety, feasibility, and high success rate of ICG FI in this application [30,33,34]. In our sample, the lymphatic drainage was partially demonstrated in 3 patients, insufficient to guide the lymphadenectomy.…”
Section: Ten Consecutive Patients With a Diagnosis Of Colon Cancer Unsupporting
confidence: 48%
“…Prior work has supported the value of ICG FI to identify aberrant nodes [28,30,[35][36][37]. [22,26,29,30,33,34,[38][39][40][41]. We have previously reported our technique of subserosal injection to visualize lymphatic drainage in a colon cancer patient [12].…”
Section: Ten Consecutive Patients With a Diagnosis Of Colon Cancer Unmentioning
ICG can be safely injected into the peritumoural subserosal and demonstrate lymphatic drainage in colon cancer. This proof of concept and proposed standards for the procedure can lead to future studies to optimize the application of image-guided precision surgery in colon cancer. Furthermore, this technique may be of value in indicating the need for more extended lymphadenectomy.
“…More novel uses of ICG have been recently described including identification of sentinel nodes and lymphatics (10). Prior studies have shown the efficacy and ability to visualize the mesenteric and central vessels for ligation (14,15).…”
Recent advances in mesenteric science have demonstrated that the mesentery is a continuous structure with a 'watershed' area at the mesenteric apex between the right colon and terminal ileum, where lymphatic flow can proceed either proximally or distally. With this new understanding of the anatomy, functional features are emerging, which can have an impact on surgical management. Fluorescence lymphangiography or lymphoscintigraphy with indocyanine green allows real-time visualization of lymphatic channels, which highlights sentinel lymph nodes and may facilitate identification of the ideal margins for mesenteric lymphadenectomy during bowel resection for colon cancer. By using this novel technology, it is possible to demonstrate a watershed area in the ileocolic region and may facilitate more precise mesenteric dissection. In the present study, we provide proof of concept for the ileocolic watershed area using fluorescence lymphangiography.
“…Fluorescence imaging using appropriate fluorophores may help achieve this. Prior studies have shown the efficacy and ability to visualize mesenteric bound and central vessels for ligation . The technology can be applied to more precise surgery, especially in right colon cancers, with the tool guiding an optimal oncological resection and avoiding the need for a CME, with its associated risks.…”
mentioning
confidence: 99%
“…Prior studies have shown the efficacy and ability to visualize mesenteric bound and central vessels for ligation. 11,12 The technology can be applied to more precise surgery, especially in right colon cancers, with the tool guiding an optimal oncological resection and avoiding the need for a CME, with its associated risks.This concept was successfully tested in a 73-year-old female presenting with a colon adenocarcinoma who underwent a laparoscopic right hemicolectomy. Once the colon was fully mobilized and the Ileocolic vessel ligated, the specimen is externalized.…”
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