Use of a lead shield for laparoscopic detection of the sentinel lymph nodes in gastric cancer

Abstract

Background: Accurate staging of lymph node metastasis by sentinel node biopsy is easily achieved in conventional open gastric surgery. Staging is not easily achieved in laparoscopic surgery, however, because of the technical difficulty in identifying sentinel nodes. We developed a laparoscopic method that involves lead shielding for detection of sentinel nodes in gastric cancer and examined the efficacy of this method.Methods: Laparoscopic sentinel node biopsy was performed in 18 patients with early gastric cancer. A combined dye‐ and radio‐guided method was used in the first 10 patients; our radio‐guided lead shield method was used in the subsequent eight cases. Laparoscopy‐assisted distal gastrectomy was performed in all patients, and dissected nodes were examined by routine hematoxylin and eosin staining. The detection rate was compared between the two groups.Results: The detection rate for sentinel nodes was higher with the radio‐guided lead shield method (88%) than with the combined dye‐ and radio‐guided method (40%). Regional lymph node metastasis was recognized in one of 18 patients, and the sentinel node was positive in this case.Conclusions: Use of a lead shield is beneficial for accurate laparoscopic detection of sentinel lymph nodes.