Abstract
BackgroundEnsuring 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.MethodsSince 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.ResultsICG 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.ConclusionsICG 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.
Highlights
Ensuring an adequate blood supply is essential to the safe performance of an anastomosis after esophagectomy and the prevention of anastomotic leakage
We evaluated blood flow of the reconstructed stomach with a photodynamic eye (PDE) after indocyanine green (ICG) injection and the incidence of anastomotic leakage and stenosis
ICG fluorescence imaging was performed with a near-infrared camera system (PDE; Hamamatsu Photonics K.K, Hamamatsu, Japan), and the images were recorded
Summary
Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. 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. The stomach is most widely used to reconstruct the alimentary tract after esophagectomy for esophageal cancer. The left gastric artery arises directly from the celiac axis. Many institutions use the stomach for reconstruction of the alimentary tract after esophagectomy. The right gastroepiploic artery and right gastric artery are preserved to supply blood to the gastric tube. The right gastroepiploic artery is preserved when a gastric tube is constructed from the greater curvature. The right gastroepiploic artery serves as the main source of blood to the reconstructed stomach
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