title: Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy.
abstract: BACKGROUND
  Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.
  
  
  METHODS
  Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.
  
  
  RESULTS
  ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside the splenic hilum in 22 (66.7%) of the 33 patients.
  
  
  CONCLUSIONS
  ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal vessels were the major blood supply for the anastomosis in most patients.
authors.affiliation: Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama city 236-0004, Japan. rino@med.yokohama-cu.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Norio
authors.initials: N
authors.lastname: Yukawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamagawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Toshio
authors.initials: T
authors.lastname: Imada
mesh_terms: D004396:Coloring Agents; D004938:Esophageal Neoplasms / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery* / Q000648:ultrastructure; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D061848:Optical Imaging / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013154:Spleen / Q000098:blood supply*; D013270:Stomach / Q000098:blood supply / Q000502:physiology / Q000648:ultrastructure
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green