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| Name | Complete Mesocolic Excision Fluorescence-Guided: In search of lymphatic flow |
| Video Uploader | Video From Gonzalo P. Martin-Martin |
| Upload Date | This Video Uploaded At 09-03-2017 17:11:33 |
| Video Discription | Total mesocolic excision fluorescence-guided: In search of lymphatic flow Introduction: The aim of this video is to describe our technique using fluorescence to assess the lymph flow to ensure a complete mesocolic excision and central vascular ligation in order to provide expertise to contribute to the standardization of this new tool. Method: 76 years male, classified as ASA II. A great tubular adenoma of the cecum with high-grade dysplasia was diagnosed. Laparoscopic right colectomy with total excision of the mesocolon is proposed. For the detection of lymph flow, we injected indocyanine green (2.5 mg/1.0 mL) into the subserosal to submucosal layer around the tumor at 1 point with a 21-gauge injection laparoscopically after trocar insertion, and observed the lymph flow using a near-infrared european system 25 minutes after injection. We also performed a total mesocolic excision with central vascular ligation in the region where the lymph flow was fluorescently observed. First lympathic node was marked based on fluorescence imaging. Results: No intraoperative or postoperative complications presented. No adverse effects were reported due to the infusion of ICG. The lymph flow was visualized intraoperatively in a satisfactory way helping the surgeon in decision making to determine an appropriate separation line of the mesentery. The operating time was 90 minutes. Patient was discharged on the fifth day after surgery. The histological result was tubular adenoma of the cecum with 14 isolated nodes without involvement including the sentinel node marked intraoperatively. The morphometric laboratory data of the specimen to audit the correct complete mesocolic excision were satisfactory according to the oncological standards. Conclusion: Fluorescence lymphography during colorectal surgery was feasible and reproducible with a minimum of added complexity. Fluorescence-guided surgery may be a helpful technique for determining an appropriate total mesocolic excision in colon neoplasms. |
| Category | Science & Technology |
| Tags | Complete Mesocolic Excision | Fluorescence | ICG | Gonzalo Martin | Olympus | yt:quality=high | Colorectal | Coloproctology | drgonzalopmartin.com | Complete Mesocolic Excision during Right Hemicolectomy for Colon Cancer | complet mesocolic | colon cancer | Complete mesocolic excision | minimally-invasive | Complete mesocolic dissection | Real-Time Fluorescence (Infrared) Laparoscopy - How it works | near-infrared | olympus | icg | indocyanine green | colon resection | laparoscopy | Gonzalo P Martin Martin |
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