IDENTIFICATION OF SENTINEL LYMPH NODE USING SUBMUCOSAL INJECTION OF INDOCYANINE GREEN AND DAVINCI FIREFLY CAMERA SYSTEM
Timothy J. Vreeland*1, Phillip S. Ge2, Jeffrey Lee2, Paul Mansfield1, Brian Badgwell1, Naruhiko Ikoma1
1Surgical Oncology, University of Texas MD Anderson, Houston, TX; 2Gastroenterology, University of Texas MD Anderson, Houston, TX
We present a robotic total gastrectomy with D2 lymph node (LN) dissection for cT1bN0 gastric cancer. We performed sentinel LN (SLN) identification using intraoperative submucosal injection of indocyanine green and visualization of the lymphatic channel with the DaVinci firefly camera system. The SLN was marked and later sent as a separate specimen. Final pathological evaluation revealed a pT1bN1 tumor with 2/70 positive LN. Importantly, the positive nodes were in the SLN specimen. SLN identification may lead to increased detection of LN metastasis by focused pathological assessment. This technique could potentially guide extent of LN dissection for early stage gastric cancer in the future.
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