ORIGINAL ARTICLE  COLON SURGERY 

Minerva Chirurgica 2019 April;74(2):165-9

DOI: 10.23736/S0026-4733.18.07831-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Robotic right colectomy with complete mesocolic excision and indocyanine green guidance

Giuseppe SPINOGLIO, Wanda PETZ, Simona BORIN, Alessandra N. PICCIOLI, Emilio BERTANI ✉

Division of Gastrointestinal Surgery, European Institute of Oncology, Milan, Italy

BACKGROUND: Robotic complete mesocolic excision (CME) has recently emerged as promising technique to enhance oncologic results in hemicolectomy for cancer. The potential near-infrared (NIR) fluorescence with indocyanine-green (ICG) dye for lymphatic mapping is under investigation and few small case-series are reported.
METHODS: ICG solution was endoscopically injected the day before surgery in patients undergoing robotic right colectomy with CME using the Da Vinci Xi® system and the bottom to up technique. During surgery the ICG was excited by light in the near-infrared (NIR) spectrum of the Firefly™ system, of the Da Vinci Xi® system for image comparison in standard white light and NIR, and real-time visualization of the lymphatic drainage.
RESULTS: Twenty patients affected by right colon cancer underwent robotic right colectomy with the bottom to up technique. No cases converted to open surgery were observed. During surgery, a fluorescent mapping of draining lymph nodes, was visualized in all the 20 patients. In seven patients (35%), lymph nodes outside the standard lymphatic basin were identified and removed.
CONCLUSIONS: The association of robotic right colectomy with the bottom to up technique and ICG-guided lymphadenectomy is a feasible and safe procedure. ICG lymphatic mapping may help to perform a correct CME, although the independent impact of these procedures on oncologic outcome deserves further investigations.

KEY WORDS: Robotics - Colectomy - Indocyanine green