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When it comes to the future of surgery, many doctors say that it will be based on Artificial Intelligence, robots, and image-guided surgery. Image-guided surgery can be based on fluorescence imaging but also on tridimensional models.
ICG has shown excellent outcomes for bowel perfusion, to identify ureter, and for oncologic surgery. It is used to identify tumors and to identify carcinomatosis, although the study will be focused on gastric cancer.
Firstly, let’s identify the pathology that must be treated. Gastric cancer survival is related to the number of lymph nodes removed, which is why the standard care is to perform a lymphadenectomy. The high lymph node ratio is associated with better survival but this high extended lymphadenectomy will mean higher morbidity.
Then, ICG can be used in gastric cancer as a lymphatic mapping and to identify the sentinel node. Sentinel node basin dissection avoids recurrence after a false-negative SN biopsy and has a high rate of success.
Dr. Morales-Conde compares ICG to two other methods, Blue Dye and Radiocolloid. The main advantage of using ICG over Radiocolloid is that sensibility is higher, there is no radioactivity, and it can detect under fat tissue. It also is important that signal stability is higher and the quantitative assessment. Last but not least, it is the only one that can be used in laparoscopic surgeries.
The conclusions are that with ICG a higher number of lymph nodes is obtained and there are no differences in terms of complications.
