title: Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer: technical notes.
abstract: BACKGROUND
  With increasing experience, sentinel node navigation has been applied even to gastric cancer. Sentinel lymph nodes are identified by injecting lymphatic tracer dye and radioisotope-labeled particles around a gastric tumor into the submucosa endoscopically. The aim of this video was to demonstrate the feasibility of laparoscopic sentinel node navigation (SLN) in gastric cancer.
  
  
  METHODS
  A 71-year-old man with a diagnosis of gastric cancer was admitted to the authors' department. The preoperative workup demonstrated a uT1 node-negative gastric cancer. The patient was scheduled for laparoscopic distal gastrectomy with SLN. The day before surgery, the patient was submitted to endoscopy. During the procedure, the radiotracer (technetium-99) was injected at four points around the tumor. The operation was performed with the patient in the Lloyd-Davies position using four trocars. After opening of the gastrocolonic ligament, the patient underwent an intraoperative endoscopy, and blue dye (patent blue) was injected at four points around the tumor. The lymphatic basin was identified with the probe and the blue dye. The sentinel node then was identified. No pickup technique was used. A standard laparoscopic gastrectomy with intracorporeal anastomosis was concluded successfully. Through a supraumbilical incision, the specimen was extracted. The sentinel node was dissected at the bench table after the operation.
  
  
  RESULTS
  The pathologic report demonstrated a gastric carcinoma, namely, pT1, pN1 (Sentinel node (Sn), 1/36), G3 gastric cancer. Only the sentinel node was positive, containing a micrometastasis. The patient's postoperative course was uneventful.
  
  
  CONCLUSIONS
  Sentinel node navigation with a double tracer during laparoscopic gastrectomy for cancer is feasible. Nevertheless, it is mandatory to standardize the method of SLN identification to increase the diagnosis of lymph node metastases.
authors.affiliation: Department of Surgery, University Vita-Salute San Raffaele, Via Olgettina, 60-20132, Milan, Italy. orsenigo.elena@hsr.it
authors.forename: Elena
authors.initials: E
authors.lastname: Orsenigo
authors.forename: Saverio
authors.initials: S
authors.lastname: Di Palo
authors.forename: Edi
authors.initials: E
authors.lastname: Viale
authors.forename: Enzo
authors.initials: E
authors.lastname: Masci
authors.forename: Carla
authors.initials: C
authors.lastname: Canevari
authors.forename: Luigi
authors.initials: L
authors.lastname: Gianolli
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
mesh_terms: D000368:Aged; D004396:Coloring Agents; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C008769:sulfan blue