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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Laparoscopic subtotal gastrectomy with ICG-oriented extended D2 (D2+) lymphadenectomy
The concept of fluorescence-guided navigation surgery based on indocyanine green (ICG) testifies to a developing interest in many fields of surgical oncology. The technique seems to be promising, also during nodal dissection in gastric and colorectal surgery in the so-called “ICG-guided nodal navigation”.
In this video, we present the clinical case of 36-year-old man with a seeming early stage antral gastric adenocarcinoma, as preoperatively defined, submitted to a laparoscopic subtotal gastrectomy and D2+ lymphadenectomy.
Before surgery, the patient was submitted to endoscopy with the objective to inject indocyanine green near the tumor (2mL injected into the mucosa 2cm proximally and 2cm distally to the tumor) in order to visualize the lymphatic basin of that tumor during the operation.
Thanks to the ICG’s fluorescence with the light emitted from the photodynamic eye of our laparoscopic system (Stryker 1588® camera), it is possible to clearly visualize both the individual lymph nodes and the lymphatic collectors which drain ICG (and lymph) of the specific mucosal area previously marked with indocyanine green.
This technique could allow for a more precise and radical nodal dissection and a safer work respecting vascular and nerve structures.
G Baiocchi, S Molfino, B Molteni, L Arru, F Gheza, M Diana
Surgical intervention
3 months ago
2503 views
9 likes
1 comment
12:41
Laparoscopic subtotal gastrectomy with ICG-oriented extended D2 (D2+) lymphadenectomy
The concept of fluorescence-guided navigation surgery based on indocyanine green (ICG) testifies to a developing interest in many fields of surgical oncology. The technique seems to be promising, also during nodal dissection in gastric and colorectal surgery in the so-called “ICG-guided nodal navigation”.
In this video, we present the clinical case of 36-year-old man with a seeming early stage antral gastric adenocarcinoma, as preoperatively defined, submitted to a laparoscopic subtotal gastrectomy and D2+ lymphadenectomy.
Before surgery, the patient was submitted to endoscopy with the objective to inject indocyanine green near the tumor (2mL injected into the mucosa 2cm proximally and 2cm distally to the tumor) in order to visualize the lymphatic basin of that tumor during the operation.
Thanks to the ICG’s fluorescence with the light emitted from the photodynamic eye of our laparoscopic system (Stryker 1588® camera), it is possible to clearly visualize both the individual lymph nodes and the lymphatic collectors which drain ICG (and lymph) of the specific mucosal area previously marked with indocyanine green.
This technique could allow for a more precise and radical nodal dissection and a safer work respecting vascular and nerve structures.
Three-trocar laparoscopic total gastrectomy and D2 lymphadenectomy with intracorporeal manual esophagojejunostomy
Background: Minimally invasive surgery (MIS) has proven to be oncologically feasible and safe. Over the last decade, a new philosophy of MIS reducing abdominal trauma and improving cosmetic results has been made popular. The authors report a three-trocar laparoscopic total gastrectomy combined with a D2 lymphadenectomy for smaller curvature gastric adenocarcinoma.
Video: A 52-year-old woman presenting with a non-differentiated gastric adenocarcinoma at the incisura angularis was admitted to our department. Preoperative work-up showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three ports (5mm, 12mm, 5mm) were placed in the abdomen. Exposure of the operative field was improved with percutaneous sutures. En-bloc total gastrectomy and omentectomy were performed with a D2 lymphadenectomy, including the nodes of stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. A completely manual end-to-side esophagojejunostomy, and a linear mechanical side-to-side jejunojejunostomy were performed, with closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
Results: Operative time was 4 hours and 45 minutes (anastomosis: 30) and perioperative bleeding amounted to 100cc. The pathological report confirmed the presence of a non-differentiated adenocarcinoma, mucinous, G3, interesting the gastric wall completely, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu and HER2/CEP17 non-amplified. During the postoperative follow-up, no recurrence was demonstrated at 12 months.
Conclusions: Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multiport laparoscopy. However, a superior cosmesis and a reduced abdominal trauma are offered.
G Dapri, HK Yang
Surgical intervention
3 years ago
2953 views
95 likes
2 comments
11:03
Three-trocar laparoscopic total gastrectomy and D2 lymphadenectomy with intracorporeal manual esophagojejunostomy
Background: Minimally invasive surgery (MIS) has proven to be oncologically feasible and safe. Over the last decade, a new philosophy of MIS reducing abdominal trauma and improving cosmetic results has been made popular. The authors report a three-trocar laparoscopic total gastrectomy combined with a D2 lymphadenectomy for smaller curvature gastric adenocarcinoma.
Video: A 52-year-old woman presenting with a non-differentiated gastric adenocarcinoma at the incisura angularis was admitted to our department. Preoperative work-up showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three ports (5mm, 12mm, 5mm) were placed in the abdomen. Exposure of the operative field was improved with percutaneous sutures. En-bloc total gastrectomy and omentectomy were performed with a D2 lymphadenectomy, including the nodes of stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. A completely manual end-to-side esophagojejunostomy, and a linear mechanical side-to-side jejunojejunostomy were performed, with closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
Results: Operative time was 4 hours and 45 minutes (anastomosis: 30) and perioperative bleeding amounted to 100cc. The pathological report confirmed the presence of a non-differentiated adenocarcinoma, mucinous, G3, interesting the gastric wall completely, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu and HER2/CEP17 non-amplified. During the postoperative follow-up, no recurrence was demonstrated at 12 months.
Conclusions: Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multiport laparoscopy. However, a superior cosmesis and a reduced abdominal trauma are offered.