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. 2014 May 22:14:18.
doi: 10.1186/1471-2342-14-18.

Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy

Yasushi Rino  1 , Norio Yukawa, Tsutomu Sato, Naoto Yamamoto, Hiroshi Tamagawa, Shinichi Hasegawa, Takashi Oshima, Takaki Yoshikawa, Munetaka Masuda, Toshio Imada
Affiliations

Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy

Yasushi Rino et al. BMC Med Imaging. .

Abstract

Background: Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.

Methods: Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.

Results: ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside the splenic hilum in 22 (66.7%) of the 33 patients.

Conclusions: ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal vessels were the major blood supply for the anastomosis in most patients.

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Figures

Figure 1
Figure 1
Schema of the categories on the basis of ICG imaging findings: 1; the gastric wall route, 2; the greater curvature route, and 3; the omentum and splenic hiatal route.
Figure 2
Figure 2
The PDE system showed blood flow from the right gastroepiploic artery, gastric wall vessels, and left gastroepiploic artery of the reconstructed stomach.
Figure 3
Figure 3
The PDE system showed blood flow from the right gastroepiploic artery, left gastroepiploic artery, and greater curvature vessels of the reconstructed stomach.
Figure 4
Figure 4
The PDE system showed blood flow from the omentum vessels, left gastroepiploic artery, splenic hiatal vessels, short gastric artery, and gastric wall vessels to the top of the reconstructed stomach.
See this image and copyright information in PMC

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