A new method of sentinel node mapping for early gastric cancer using a fluorescent laparoscope that can adjust the intensity of excitation light and quantify the intensity of indocyanine green fluorescence: Report of a case

Highlights • VISION SENSE® is a new near-infrared fluorescence laparoscope, and allows adjustment of the intensity of excitation light and quantification of the intensity of ICG fluorescence during observation. • Using VISION SENSE®, when many ICG-positive lymph nodes are observed, we can select lymph nodes by quantifying ICG fluorescence during surgery. • This procedure might improve SN mapping for early gastric cancer.
Introduction One of the drawbacks of indocyanine green (ICG) fluorescence sentinel node (SN) mapping is the impossibility of quantifying lymph node fluorescence during surgery. VISION SENSE® is a new near-infrared fluorescence laparoscope for bright-field full-color observation, and provides the ability to adjust the intensity of excitation light and quantify the intensity of ICG fluorescence during observation. We report the case of a patient who underwent ICG SN mapping for early gastric cancer using VISION SENSE®. Presentation of case A woman in her 60 s was diagnosed with cType0-IIc early gastric cancer located in the anterior wall of the middle gastric body (25 mm in diameter, cT1b, cN0, cM0, cStage IA). Contrast-enhanced computed tomography showed no metastases. Laparoscopy assisted distal gastrectomy with D1+ lymph node dissection and SN mapping with ICG fluorescence using the VISION SENSE® were successfully performed. Using VISION SENSE®, we could select those lymph nodes objectively showing high intensity by quantifying ICG fluorescence during surgery. The pathological diagnosis was well-differentiated adenocarcinoma, pT1a, N0, M0, pStage IA. No ICG-positive lymph nodes (8 nodes) contained metastases. Postoperative course was good, with no complications. Discussion The use of VISION SENSE® allowing adjustment of excitation light and quantification of ICG fluorescence intensity might decreased the false-negative rate for SNs and increased the sensitivity of the ICG for detecting SNs. Conclusion We successfully performed ICG SN mapping for early gastric cancer using VISION SENSE®.