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Fluorescence vessel and ureter navigation during laparoscopic lateral lymph node dissection.

Shunjin Ryu¹, Keigo Hara², Takahiro Kitagawa²

¹Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan. systematic.ryu1121@gmail.com.

Langenbeck'S Archives of Surgery

|August 11, 2021

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Fluorescence navigation using near-infrared ray fluorescent ureteral catheters and indocyanine green enhances safety in laparoscopic lateral lymph node dissection for rectal cancer by clearly identifying ureters and internal iliac artery branches.

Area of Science:

Surgical Oncology
Minimally Invasive Surgery
Medical Imaging

Background:

Lateral lymph node metastasis in lower rectal cancer is a local disease treated with lateral lymph node dissection (LLND).
Laparoscopic LLND is challenging due to the need to dissect the ureter and autonomic nerves, and the complex branching of the internal iliac artery.
Novel fluorescence navigation techniques are being explored to improve safety and precision in these procedures.

Purpose of the Study:

To investigate the utility of fluorescence navigation for ureter and vessel identification during laparoscopic lateral lymph node dissection (LLND).
To assess the safety and feasibility of using a near-infrared ray fluorescent ureteral catheter (NIRFUC) and indocyanine green (ICG) in laparoscopic LLND.

Main Methods:

A study involving 14 patients undergoing laparoscopic LLND with fluorescence navigation.

Keywords:

Colorectal cancer Fluorescence Lateral lymph node dissection Navigation Ureter Vessel

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Utilized near-infrared ray fluorescent ureteral catheter (NIRFUC) insertion in 11 patients and fluorescence vessel navigation (FVN) with intraoperative indocyanine green (ICG) injections in all 14 patients.

Evaluated ureter visibility, internal iliac artery branching patterns, and surgical outcomes.

Main Results:

Ureters were clearly identified using fluorescence in all 11 patients with NIRFUC.
Fluorescence vessel navigation (FVN) successfully visualized the internal iliac, umbilical, and superior vesical arteries in all patients.
Accurate identification of internal iliac artery branching patterns (Adachi classification) was achieved in 89% of sides, with no ureteral or vessel injuries reported.

Conclusions:

Fluorescence navigation is a feasible and safe technique for laparoscopic LLND.
This method enhances the visualization of critical anatomical structures, potentially increasing surgical safety.
The use of NIRFUC and ICG-guided FVN shows promise for improving outcomes in laparoscopic rectal cancer surgery.