Fluorescence lymphangiography-guided full-thickness oncologic gastric resection

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Imaging

Background:

• A novel hybrid endoscopic/laparoscopic technique for gastric resection was developed.
• This technique utilizes fluorescence lymphangiography to identify lymphatic pathways and sentinel lymph nodes.

Purpose of the Study:

• To assess the feasibility of a hybrid endoscopic/laparoscopic gastric resection.
• To evaluate the use of fluorescence lymphangiography in guiding the resection and lymphatic basin dissection.

Main Methods:

• Eight pigs underwent the hybrid resection procedure.
• Indocyanine green was used for fluorescence guidance to map lymphatic spread.
• Near-infrared (NIR) laparoscopy and angiography assessed stomach perfusion.
• Dynamic MRI evaluated gastric motility and function.

Main Results:

• The hybrid resection and sentinel lymph node dissection were successfully performed without complications.
• NIR angiography confirmed good perfusion of the remaining stomach.
• Preserved gastric emptying was observed in acute models and one survival group; reduced function occurred in another survival group.

Conclusions:

• Fluorescence-lymphangiography guided hybrid resection is a feasible technique for extensive gastric resection.
• The extent of dissection along the lesser curvature impacts post-operative gastric function, requiring further optimization.