Tracer-Guided Lymphadenectomy Under Fluorescent Imaging 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 (ICG) 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 ICG tracer-guided suprapancreatic lymph node dissection for gastric cancer using a left approach under natural light and NIR imaging in 3 modes of illumination: infrared (lymph nodes fluoresce white), green fluorescence (lymph nodes fluoresce green), and blue or color segmented fluorescence (proprietary processing software maps relative fluorescence brightness to a contrasting color scale overlaid; increasing fluorescence levels transition from blue to yellow to red). Click the Related Article link for additional videos and a complete discussion of the procedure and findings from a trial comparing it with non-ICG tracer-guided lymph node dissection.