title: Indocyanine green injection for detecting sentinel nodes using color fluorescence camera in the laparoscopy-assisted gastrectomy.
abstract: OBJECTIVE
  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 µg/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 µg/mL, injected on the day before operation and intraoperative injection, was examined. Then, 10 cases injected 50 µg/mL ICG on the day before operation were examined.
  
  
  RESULTS
  The ICG fluorescence of the patient injected 100 µg/mL was too intense and that of the patient injected 25 µg/mL was too faint. Sentinel lymph nodes were detected in all of 10 cases injected 50 µg/mL, the day before operation and number of sentinel lymph nodes per patient was 3.6 ± 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.
  
  
  CONCLUSIONS
  The present study shows that HEMS-guided abdominal surgery is feasible under room light. Submucosal injection of 0.5 mL × 4 of 50 µg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery.
authors.affiliation: Department of Surgery, Center for Digestive Diseases, International University of Health and Welfare, Mita Hospital, Japan. masashi@iuhw.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Junko
authors.initials: J
authors.lastname: Kuroda
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ohta
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nakamura
authors.forename: Junichi
authors.initials: J
authors.lastname: Saito
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sato
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Beck
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005456:Fluorescent Dyes / Q000008:administration & dosage; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007267:Injections; D007564:Japan; D010535:Laparoscopy; D008163:Luminescent Measurements / Q000295:instrumentation*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green