TheICG fluorescence of the patient injected 50 µg/mL intraoperatively was too intense and too many ICG fluorescence-positive lymph nodes existed (Fig. 4a). In this case, sentinel lymphatic basins could be observed, that is, they were along the right gastroepiploic artery (No. 4d–No. 6) and the left gastric artery (No. 3–No. 7) (Fig. 4b). ICG fluorescence was not observed in the lymphatic vessels along the right

gastric artery (No. 5) and the left gastroepiploic artery (No. 4sb). 3 50 µg/mL, the day before operation. Ten patients were enrolled in the group. Sentinel lymph nodes were detected in all cases (Fig. 5) and number of sentinel lymph nodes per patient was 3.6 ± 2.1. Metastasis was observed in one case. In this case, 12 out of 37 lymph nodes were positive for the metastasis. ICG fluorescence-positive sentinel find more nodes VX-770 mw were found along right gastroepiploic

vessels (No. 4d in JCGC) and all of them were positive for the metastasis. The present study shows that submucosal injection of 0.5 mL × 4 of 50 µg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery. Sentinel nodes was detected in all of the patients studied, and mean number of sentinel nodes was 3.6 per patient and similar to that of dual tracer method. Mean number of sentinel nodes per patient by dye method was reported as about 2–2.8.7,16 That was 3.3–4.1 per case1,17 by dual tracer method. In this concentration and timing of ICG injection, clinical case will be accumulated and sensitivity and accuracy of sentinel node mapping will be examined using color fluorescence camera, HEMS, in the laparoscopy-assisted gastrectomy. The present study also shows that HEMS-guided abdominal surgery is quite feasible. As it is written in introduction, HEMS is the novel system for detecting both color image and near-infrared rays under room light. After the experiments in swine,13 it was decided to use HEMS in the clinical surgery for digestive diseases. In the clinical appreciation of HEMS, medchemexpress the operation

can be continued, simultaneously, under the guidance of ICG fluorescence. Sampling of the sentinel lymph nodes can be performed on a back table in the same operating room under the room light. Lymph node metastasis was found in a case injected 50 µg/mL of ICG on the day before operation. All of four sentinel lymph nodes were positive for metastasis. This case encouraged us to continue the study and accumulate patients to prove the sensitivity and accuracy of the sentinel node mapping. More than half of patients underwent laparoscopy-assisted pylorus preserving gastrectomy in the present study. In our operation, the infrapyloric lymph nodes (No. 6 in JCGC) were dissected while the infrapyloric artery was preserved. We also preserve the right gastric artery and the suprapylolric lymph nodes (No. 5 in JCGC).