Surgical usefulness of indocyanine green as an alternative to India ink for endoscopic marking

Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Yano, Masahiko; Sasaki, Yo; Kutsukake, Kentaro; Yamada, Terumasa; Miyashiro, Isao; Ohigashi, Hajime; Iishi, Hiroyasu; Ishikawa, Osamu; Imaoka, Shingi

doi:10.1007/s00464-008-9938-4

Cited by 98 publications

(80 citation statements)

References 21 publications

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“…Preoperative tattooing with dye injection is probably the simplest of these, and is often used in colon surgery [17][18][19]. However, as observed in this study, the injected dye can easily spread across the serosal surface in the case of gastric surgery, which sometimes makes it difficult to …”

Section: Discussionmentioning

confidence: 93%

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

et al. 2016

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We have developed a new method to localize a tumor during totally laparoscopic gastrectomy that uses intraoperative laparoscopic ultrasonography combined with preoperative clipping and tattooing. One or 2 days before the surgery, endoscopic clipping was performed just proximal to the tumor, followed by tattooing with India ink at the clipping site. Examination by intraoperative laparoscopic ultrasonography was performed at the tattooed site to detect the clips. The resection line of the stomach was determined with use of the detected clips as a marker of the proximal margin of the tumor. This method was attempted in 14 patients who underwent totally laparoscopic gastrectomy, and the clips were successfully identified in all patients. The clips were visualized as several layers of a hyperechoic bar, which was termed a ''ladder sign.'' The mean time from insertion of the laparoscopic probe to identification of the clips was 2 min. The ladder sign is an important finding in this method.

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Section: Discussionmentioning

confidence: 93%

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

et al. 2016

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“…ICG enables rapid intraoperative visualisation of SLNs and lymphatic drainage in patients with breast and early gastric cancer [5-7, 15]. ICG was initially recommended as a tattooing agent for colonic lesions to aid perioperative localisation [16-18] as there were no reports of complications such as focal peritonitis, abscess formation, postoperative adhesions, and ileus seen with the use of India ink [19-21]. However, its use as a tattooing agent is limited to patients undergoing surgery within 8 days after endoscopic injection, as the dye dissipates through lymphatic channels due to its small molecular size [16].…”

Section: Resultsmentioning

confidence: 99%

“…ICG was initially recommended as a tattooing agent for colonic lesions to aid perioperative localisation [16-18] as there were no reports of complications such as focal peritonitis, abscess formation, postoperative adhesions, and ileus seen with the use of India ink [19-21]. However, its use as a tattooing agent is limited to patients undergoing surgery within 8 days after endoscopic injection, as the dye dissipates through lymphatic channels due to its small molecular size [16]. More recently, its fluorescence properties have been utilised for intraoperative localisation of colorectal neoplasms and associated SLNs [22-26] in patients undergoing surgery.…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

Currie¹

2019

Eur Surg Res

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Sentinel lymph node mapping (SLNM) may play a significant role in future delivery of colon cancer surgery because of an increase in early-stage, node-negative disease due to national bowel cancer screening programmes. Traditionally, colon lymphatic drainage has not been thought relevant as the operative approach cannot be tailored. Recent advances in local and endoscopic risk-reducing interventions for colonic malignancy have caused a rethink in approach. SLNM was initially attempted with blue dye techniques with limited success. Technological improvement has allowed surgeons to use near-infrared (NIR) light and NIR active tracers such as indocyanine green. This review provides an overview of the current status of intraoperative lymph node mapping in the colon, identifies challenges to the delivery of the techniques, and discusses potential solutions that may help SLNM play a role in improving the delivery of surgical care for patients with colon cancer.

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“…The tumor site could not be visually recognized after an interval of 5 days in 1 patient who was obese with BMI of 27.3. A previous report stated that ICG visibility was dependent not only on the interval between endoscopic marking and surgery but also on other factors, such as the thickness of pericolonic fat, omentum, mesentery, and the posterior abdominal wall [17] . In this study, we injected ICG only at the distal side of the tumor regardless of the location of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Miyoshi et al [17] suggested that the duration of ICG visibility was up to 8 days after injection, if ICG was used as a green dye. The ICG concentration used in that study was 1.25%, and the ICG used by Lee et al [18] and Price et al [9] were 1 and 1.25%, respectively, if it was used as a green dye.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Identification of Colonic Tumor Sites Using a Near-Infrared Fluorescence Endoscopic Imaging System and Indocyanine Green

Watanabe¹,

Murakami²,

Ozawa³

et al. 2017

Dig Surg

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Background: This study aimed to investigate the feasibility of the PINPOINT® Endoscopic Fluorescence Imaging System (PINPOINT) for intraoperative identification of colonic tumor sites during laparoscopic colorectal surgery. Methods: Eighty consecutive patients with colorectal cancer were prospectively enrolled. Preoperatively, 0.5 mL of indocyanine green (ICG; 2.5 mg/mL) was injected into the submucosal space only at the distal side of the tumor under colonoscopy. Intraoperatively, we identified the tumor site on a PINPOINT image in which near-infrared fluorescence was superimposed in pseudocolor on a white light image. We estimated the intraoperative visibility rate of the tumor site and safety of ICG injection and assessed the interobserver variability of visibility grade between 2 surgeons. Results: The intraoperative visibility rate of the tumor site was 93.8% (75/80). The visibility rate at an interval between injection and surgery of <7 days was significantly better than that at an interval of ≥10 days (p < 0.001). The kappa value between 2 observers was 0.827 (95% CI 0.635-1.019) with an agreement rate of 92.5%. There were no preoperative adverse reactions to ICG or intraoperative complications. Conclusions: Using ICG with the PINPOINT for identifying colonic tumor sites was feasible without any adverse effects during laparoscopic colorectal surgery.

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Surgical usefulness of indocyanine green as an alternative to India ink for endoscopic marking

Abstract: This study supports the use of ICG as a safe technique that can be identified reliably during operations performed within 8 days after endoscopic injection.

Cited by 98 publications

References 21 publications

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

Intraoperative Identification of Colonic Tumor Sites Using a Near-Infrared Fluorescence Endoscopic Imaging System and Indocyanine Green

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