Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
Surg Endosc. 2011 May;25(5):1672-6. doi: 10.1007/s00464-010-1405-3. Epub 2010 Oct 26.
Indocyanine green (ICG) fluorescence imaging is a promising technique for detection of sentinel node (SN) as it avoids unnecessary resection. However, the ICG fluorescence imaging system cannot be used in laparoscopic surgery because of technological difficulties.
A prototype laparoscopic detection system comprising an electron multiplier charge-coupled device (EM-CCD) as the detector and a xenon lamp as the light source was developed. The CCD camera head was attached to the end of a specially designed laparoscope that could transmit ICG fluorescence. The system allows visualization of both color and fluorescence images. Laparoscopic surgery in ten patients with gastric cancer included SN biopsy using ICG dye, ICG fluorescence images using our system, and laparoscopy-assisted gastrectomy (LAG) with lymphadenectomy. SNs were sliced into 2-mm sections for histological examination and imprint cytology.
Immediately after intraoperative ICG injection by endoscopy, the laparoscopic ICG fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and traced the moving injected dye, whereas lymph vessels and nodes were hardly recognized by ICG green color through a standard laparoscope. Surgeons could confirm the removed lymph nodes stained with ICG by fluorescent imaging. SNs were successfully detected in all patients. Three patients had suspicious metastases in the SNs; two patients had lymph node metastases only in the SNs.
Our newly developed laparoscopic ICG fluorescence imaging system is promising in the detection of SNs in laparoscopic gastric cancer surgery. The preliminary results suggest an easier and shorter learning curve of dye-guided SN biopsy in laparoscopic gastric surgery.
吲哚菁绿（ICG）荧光成像是一种很有前途的检测前哨淋巴结（SN）的技术，因为它可以避免不必要的切除。然而，由于技术上的困难，ICG 荧光成像系统不能用于腹腔镜手术。
开发了一种由电子倍增电荷耦合器件（EM-CCD）作为探测器和氙灯作为光源的腹腔镜检测系统原型。CCD 摄像头安装在专门设计的腹腔镜的末端，可以传输 ICG 荧光。该系统允许同时观察彩色和荧光图像。在 10 例胃癌患者中进行了腹腔镜手术，包括使用 ICG 染料进行 SN 活检、使用我们的系统进行 ICG 荧光图像检查以及腹腔镜辅助胃切除术（LAG）和淋巴结清扫术。SN 被切成 2 毫米的切片进行组织学检查和印片细胞学检查。
在胃镜检查中进行术中 ICG 注射后，腹腔镜 ICG 荧光成像系统可以很容易地观察到从原发性胃肿瘤向淋巴结引流的淋巴管，并追踪注射染料的移动，而通过标准腹腔镜几乎无法识别淋巴管和淋巴结。外科医生可以通过荧光成像确认切除的带有 ICG 的淋巴结。所有患者均成功检测到 SN。3 例患者 SN 有可疑转移；2 例患者仅在 SN 中发现淋巴结转移。
我们新开发的腹腔镜 ICG 荧光成像系统在腹腔镜胃癌手术中检测 SN 是有前途的。初步结果表明，在腹腔镜胃癌手术中，染料引导的 SN 活检更容易学习，学习曲线更短。
