Double indocyanine green technique of robotic right colectomy: Introduction of a new technique
Jarek Kobiela1, Emilio Bertani2, Wanda Petz3, Cristiano Crosta3, Giuseppe De Roberto3, Simona Borin3, Dario Ribero2, Diana Baldassari2, Piotr Spychalski1, Giuseppe Spinoglio2
1 Medical University of Gdansk, General, Endocrine and Transplant Surgery, Gdansk, Poland
2 European Institute of Oncology (IEO), Hepatobiliary, Pancreatic and Digestive Program, Milan, Italy
3 European Institute of Oncology (IEO), Division of Endoscopy, Milan, Italy
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 3A Sklodowskiej Str., 80-210 Gdansk
Source of Support: None, Conflict of Interest: None
In robotic right hemicolectomy for colorectal cancer (CRC), appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualisation of lymph nodes and blood flow with near-infrared (NIR) fluorescence DaVinci® imaging system is a recent development. Herein, we present an improved robotic modified complete mesocolic excision (mCME) technique using indocyanine green (ICG) fluorescence. Before surgery, ICG is injected into the submucosa around the tumour with endoscopy for intraoperative detection of lymph nodes. Robotic mCME with central vascular ligation is performed, supplemented in most of the cases with selective extended lymphadenectomy. Intestinal blood flow before anastomosis is evaluated by administering ICG intravenously and NIR visualisation. Visualisation of the lymph nodes with ICG facilitates standard mCME lymphadenectomy and enables extended lymphadenectomy. Blood flow of the intestinal walls of the anastomotic site can be assessed and determines the extent of intestinal resection. Robotic double ICG technique for robotic right hemicolectomy enables improved lymphadenectomy and warrants the extent of intestinal resection; thus, becoming a strong candidate for gold standard in robotic resections of the right colon for CRC.