Endoscopic Injection of Indocyanine Green (ICG) Tracer to Guide Lymph Node Dissection During Laparoscopic Radical Gastrectomy for Gastric Cancer

Radical lymphadenectomy can improve tumor staging accuracy and long-term survival of patients with gastric cancer. The procedure is typically performed by eye and depends on a surgeon’s experience. Indocyanine green near-infrared (NIR) fluorescent imaging has improved sentinel lymph node localization in other cancers and has been incorporated into laparoscopic device technology. This procedure video illustrates injection of ICG tracer before a planned laparoscopic gastrectomy for gastric cancer. A day before the procedure, the ICG powder is dissolved in sterile water and the prepared solution is injected along the submucosa of the stomach at 4 points around the primary tumor. The following day, the gastrectomy is performed using a surgical system with a fluorescence mode to obtain NIR images of surrounding lymph nodes. Lymph node–bearing soft tissue is retrieved, and the lymph node itself is dissected in vitro under direct NIR imaging. Click the Related Article link for videos of the lymph node dissection procedures and for results of a trial testing the effect of the procedure on lymph node retrieval.