title: Visualization of Lymph/Blood Flow in Laparoscopic Colorectal Cancer Surgery by ICG Fluorescence Imaging (Lap-IGFI).
abstract: OBJECTIVE
  In laparoscopic colorectal cancer (Lap-CRC) surgery, determination of a suitable mesentery division line and the appropriate degree of lymphadenectomy by tracing the blood supply is critical. We performed visualization of the lymph and blood flow by laparoscopic indocyanine green (ICG) fluorescence imaging (Lap-IGFI).
  
  
  METHODS
  ICG is injected into the submucosa near the tumor via colonoscopy, and the lymph flow is observed. Intestinal blood flow is evaluated by administering ICG intravenously.
  
  
  RESULTS
  For lymph flow, visualization of the main lymph node basin helped to determine the surgical division line for cases in which the blood flow was not completely visualized. Lap-IGFI changed the surgical plan of the lymphadenectomy in 23.5 %. In our experience, the metastatic rate of ICG-positive nodes was 10.0 %, and the metastatic rate of ICG-negative nodes was 5.3 %. Furthermore, there were no metastatic nodes that were ICG negative more than 5 cm from the tumor. For blood flow, the blood flow distribution of the intestinal wall from the last branch of the vasa recta of the anastomotic site was clearly visualized and proved useful in choosing the extent of intestinal resection. Lap-IGFI changed the surgical plan of the extensive intestinal resection in 16.7 %.
  
  
  CONCLUSIONS
  Lap-IGFI can noninvasively provide detailed lymph and blood flow information and is a useful device to aid in the accurate identification of individual patients' lymph drainage. This helps dictate adequate lymphadenectomy and the extent of intestinal resection in Lap-CRC surgery.
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. gori.920@ivy.ocn.ne.jp.
authors: Naoto
authors: N
authors: Nishigori
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. fkoyama@naramed-u.ac.jp.
authors: Fumikazu
authors: F
authors: Koyama
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Tadashi
authors: T
authors: Nakagawa
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Shinji
authors: S
authors: Nakamura
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Takeshi
authors: T
authors: Ueda
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Takashi
authors: T
authors: Inoue
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Keijirou
authors: K
authors: Kawasaki
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Shinsaku
authors: S
authors: Obara
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Takayuki
authors: T
authors: Nakamoto
authors: Department of Endoscopy and Ultrasound, Nara Medical University, Kashihara, Nara, Japan.
authors: Hisao
authors: H
authors: Fujii
authors: Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
authors: Yoshiyuki
authors: Y
authors: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061848:Optical Imaging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green