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More recently, few scientists have attempted to figure out how to improve the careful recognizable proof of the lymphatic waste courses and lymph node stations during radical gastrectomy in this way beginning another examination outskirt in this field called "navigation surgery". Among the distinctive detailed arrangements, the presentation of the indocyanine green has drawn consideration for its attributes, a fluorescence colour that can be identified in the near-infrared spectral band. A fluorescence imaging innovation has been coordinated with frameworks of lymph node dissection in laparoscopic and robotic gastrectomy surgery for gastric cancer. Current confirmations uncover that ongoing vessel navigation by using indocyanine green fluorescence during laparoscopic gastrectomy was demonstrated doable with negligible complications. Its utilization may empower the presentation of fruitful robotic or laparoscopic pylorus-preserving gastrectomy with a decrease in unintended intraoperative wounds, for example, second rate polar dead tissue of the spleen during laparoscopic gastrectomy. The clinical ramifications of utilization of indocyanine green in laparoscopic and robotic gastrectomy for gastric cancer was, in any event, for surgeons with a significant level of involvement with laparoscopic D2 dissection, the near-infrared imaging framework can fill in as a complimentary apparatus to affirm total lymphatic node dissection in patients with atypical life structures. With some restrictions the incorporated innovation of indocyanine green fluorescence with near-infrared imaging systems was practical and a promising strategy for lymphatic mapping in laparoscopic and robotic gastrectomy for gastric cancer.


Indocyanine green; Gastric cancer; Laparoscopic gastrectomy; Near-infrared image; Robotic gastrectomy

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How to Cite
Coco, D., & Leanza, S. (2021). Assessment of the Completeness of Lymph Node Dissection Using Indocyanine Green in Laparoscopic and Robotic Gastrectomy for Gastric Cancer – A Review. Journal of Gastric Surgery, 3(1), ONLINE FIRST.


    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
    2. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA: a cancer journal for clinicians. 2014;64(1):9-29.
    3. Ajani JA, Bentrem DJ, Besh S, D’Amico TA, Das P, Denlinger C et al. Gastric cancer, version 2.2013. Journal of the national comprehensive cancer network. 2013;11(5):531-46.
    4. Hanazaki K, Sodeyama H, Wakabayashi M, Miyazawa M, Yokoyama S, Sode Y et al. Surgical treatment of gastric cancer detected by mass screening. Hepato-gastroenterology.1997;44(16):1126-32.
    5. Tsujitani S, Oka S, Saito H, Kondo A, Ikeguchi M, Maeta M et al. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery. 1999;125(2):148-54.
    6. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surgical laparoscopy & endoscopy. 1994;4(2):146-8.
    7. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T et al. Robotics in general surgery: personal experience in a large community hospital. Archives of surgery. 2003;138(7):777-84.
    8. Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surgical Clinics. 2003;83(6):1429-44.
    9. Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surgical endoscopy. 2007;21(9):1662-6.
    10. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH et al. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Archives of Surgery. 2011;146(9):1086-92.
    11. Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ. Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surgical endoscopy. 2014;28(9):2606-15.
    12. Fang WL, Huang KH, Chen JH, Lo SS, Hsieh MC, Shen KH et al. Comparison of the survival difference between AJCC 6th and 7th editions for gastric cancer patients. World journal of surgery. 2011;35(12):2723-9.
    13. Fang WL, Huang KH, Lan YT, Chen MH, Chao Y, Lo SS et al. The risk factors of lymph node metastasis in early gastric cancer. Pathology & Oncology Research. 2015;21(4):941-6.
    14. Yano K, Nimura H, Mitsumori N, Takahashi N, Kashiwagi H, Yanaga K. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer. 2012;15(3):287-91.
    15. Mitsumori N, Nimura H, Takahashi N, Kawamura M, Aoki H, Shida A et al. Sentinel lymph node navigation surgery for early stage gastric cancer. World journal of gastroenterology: WJG. 2014;20(19):5685.
    16. Kusano M, Tajima Y, Yamazaki K, Kato M, Watanabe M, Miwa M. Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Digestive surgery. 2008;25(2):103-8.
    17. Caesar J. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin. Sci.1961;21:43-57.
    18. Cimmino VM, Brown AC, Szocik JF, Pass HA, Moline S, De SK et al. Allergic reactions to isosulfan blue during sentinel node biopsy—a common event. Surgery. 2001;130(3):439-42.
    19. Bostick P, Esner R, Glass E, Kelley M, Sarantou T, Foshag LJ et al. Comparison of blue dye and probe-assisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins. Archives of Surgery. 1999;134(1):43-9.
    20. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. Journal of Clinical Oncology. 1997;15(6):2345-50.
    21. Miyashiro I, Kishi K, Yano M, Tanaka K, Motoori M, Ohue M et al. Laparoscopic detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging. Surgical endoscopy. 2011;25(5):1672-6.
    22. Rino Y, Yukawa N, Sato T, Yamamoto N, Tamagawa H, Hasegawa S et al. Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy. BMC medical imaging. 2014;14(1):18.
    23. Miyashiro I, Miyoshi N, Hiratsuka M, Kishi K, Yamada T, Ohue M et al. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Annals of surgical oncology. 2008;15(6):1640-3.
    24. Tajima Y, Yamazaki K, Masuda Y, Kato M, Yasuda D, Aoki T et al. Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Annals of surgery. 2009;249(1):58-62.
    25. Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H et al. Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer. 2013;16(4):615-20.
    26. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. British Journal of surgery. 1995;82(3):346-51.
    27. Suh YS, Han DS, Kong SH, Kwon S, Shin CI, Kim WH et al. Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer. Annals of surgery. 2014;259(3):485-93.
    28. Sawai K, Takahashi T, Fujioka T, Minato H, Taniguchi H, Yamaguchi T. Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery. The American journal of surgery. 1995;170(3):285-8.
    29. Kim M, Son SY, Cui LH, Shin HJ, Hur H, Han SU. Real-time vessel navigation using indocyanine green fluorescence during robotic or laparoscopic gastrectomy for gastric cancer. Journal of gastric cancer. 2017;17(2):145-53.
    30. Kim YM, Baek SE, Lim JS, Hyung WJ. Clinical application of image-enhanced minimally invasive robotic surgery for gastric cancer: a prospective observational study. Journal of Gastrointestinal Surgery. 2013;17(2):304-12.
    31. Herrera‐Almario G, Patane M, Sarkaria I, Strong VE. Initial report of near‐infrared fluorescence imaging as an intraoperative adjunct for lymph node harvesting during robot‐assisted laparoscopic gastrectomy. Journal of surgical oncology. 2016;113(7):768-70.
    32. Kim TH, Kong SH, Park JH, Son YG, Huh YJ, Suh YS et al. Assessment of the completeness of lymph node dissection using near-infrared imaging with indocyanine green in laparoscopic gastrectomy for gastric cancer. Journal of gastric cancer. 2018;18(2):161-71.
    33. Kim M, Son SY, Cui LH, Shin HJ, Hur H, Han SU. Real-time vessel navigation using indocyanine green fluorescence during robotic or laparoscopic gastrectomy for gastric cancer. Journal of gastric cancer. 2017;17(2):145-53.
    34. Kinami S, Oonishi T, Fujita JU, Tomita Y, Funaki H, Fujita H et al. Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer. Oncology letters. 2016;11(6):4055-62.
    35. Macedo AL, Schraibman V. Intraoperative near-infrared fluorescent imaging during robotic operations. Einstein (São Paulo). 2016;14(4):577-9.
    36. Van der Vorst JR, Schaafsma BE, Hutteman M, Verbeek FP, Liefers GJ, Hartgrink HH et al. Near‐infrared fluorescence‐guided resection of colorectal liver metastases. Cancer. 2013;119(18):3411-8.
    37. Schlottmann F, Barbetta A, Mungo B, Lidor AO, Molena D. Identification of the lymphatic drainage pattern of esophageal cancer with near-infrared fluorescent imaging. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2017;27(3):268-71.
    38. Herrell SD, Galloway RL, Su LM. Image-guided robotic surgery: update on research and potential applications in urologic surgery. Current opinion in urology. 2012;22(1):47-54.
    39. Son T, Hyung WJ. Robotic gastrectomy for gastric cancer. Journal of surgical oncology. 2015;112(3):271-8.
    40. Marescaux J, Diana M. Inventing the future of surgery. World journal of surgery. 2015;39(3):615-22.
    41. Morrow M, Rademaker AW, Bethke KP, Talamonti MS, Dawes LG, Clauson J et al. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery. 1999;126(4):714-22.
    42. Sanidas EE, de Bree E, Tsiftsis DD. How many cases are enough for accreditation in sentinel lymph node biopsy in breast cancer?. The American Journal of Surgery. 2003;185(3):202-10.
    43. Cox CE, Salud CJ, Cantor A, Bass SS, Peltz ES, Ebert MD et al. Learning curves for breast cancer sentinel lymph node mapping based on surgical volume analysis. Journal of the American College of Surgeons. 2001;193(6):593-600.
    44. Lee JH, Ryu KW, Lee SE, Cho SJ, Lee JY, Kim CG et al. Learning curve for identification of sentinel lymph node based on a cumulative sum analysis in gastric cancer. Digestive surgery. 2009;26(6):465-70.