Fluorescence lymphangiography-guided full-thickness oncologic gastric resection View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-02

AUTHORS

Seong-Ho Kong, Francesco Marchegiani, Renato Soares, Yu-yin Liu, Yun-Suhk Suh, Hyuk-Joon Lee, Bernard Dallemagne, Han-Kwang Yang, Jacques Marescaux, Michele Diana

ABSTRACT

BACKGROUND: We aimed to assess the feasibility of a novel hybrid endoscopic/laparoscopic non-exposed, full-thickness, single-wall gastric resection technique guided by a fluorescence lymphangiography to identify the lymphatic pathway and the sentinel node basin. METHODS: Eight large white pigs (4 acute and 4 survival models) were included. Indocyanine green was injected submucosally around a pseudo-tumor at four points (1 ml, 0.1 mg/ml). The lymphatic spreading pathway was identified by the means of near-infrared (NIR) laparoscopic camera, and the resection line was planned outside of the fluorescent signals, to include all the potential lymphatic channels. Lymph node (LN) dissection was performed at greater curvature side and the infrapyloric area preserving the infragastric artery for all pigs. At the lesser curvature, 3-4 branches of the gastric artery were preserved in all acute and in two survival (group A), while in the remaining animals, 1-2 branches were preserved (group B). Perfusion of the remaining stomach was examined by NIR angiography. The gastric motility and function were evaluated by the means of a dynamic MRI immediately after the procedure and repeated after 1 week in surviving animals. RESULTS: The hybrid full-thickness resection with bilateral sentinel LN basin dissection were successfully performed with no intra-operative or post-operative complications. The removed specimen was including all the area with florescent signal. The remaining stomach demonstrated a good perfusion at the NIR angiography. The dynamic MRI revealed a preserved emptying function in the acute animals and in the group A, and a loss of function in the group B. CONCLUSIONS: Fluorescence-lymphangiography guided hybrid resection was feasible to remove a relatively large part of the stomach including the lymphatic spreading pathway and sentinel basin. The extent of dissection in the lesser curvature side can affect the post-operative function and further researches are warranted to optimize the concept. More... »

PAGES

1-13

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-018-6402-y

DOI

http://dx.doi.org/10.1007/s00464-018-6402-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1106366036

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30167951


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262 IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
263 rdf:type schema:Organization
264 https://www.grid.ac/institutes/grid.420397.b schema:alternateName Research Institute against Digestive Cancer
265 schema:name Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
266 IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
267 IRCAD, Research Institute against Cancer of the Digestive System, 1, Place de l’Hôpital, 67091, Strasbourg, France
268 rdf:type schema:Organization
269 https://www.grid.ac/institutes/grid.480511.9 schema:alternateName Institut Hospitalo-Universitaire de Strasbourg
270 schema:name IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
271 rdf:type schema:Organization
 




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