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Aims: The aim of this video is to describe our technique using fluorescence to assess the lymph flow so as to ensure a complete mesocolic excision and central vascular ligation in order to provide expertise to contribute to the standardization of this new tool.
Methods: Laparoscopic right colectomy with total excision of the mesocolon was proposed. For the detection of lymph flow, we injected indocyanine green dye (1 milliliter of 25 milligrams dye dilution in 10 milliliters of distilled water) into the subserosal to submucosal layer around the tumor at 1 point with a 21-gauge injection laparoscopically after trocar insertion, and observed the lymph flow using a near-infrared system (Visera Elite II, Olympus) after injection. We also performed a total mesocolic excision with central vascular ligation in the region where the lymph flow was fluorescently observed.
Results: The morphometric laboratory data of the specimen to audit the correct complete mesocolic excision were satisfactory according to the oncological standards.
Conclusion: Fluorescence lymphography during colorectal surgery was feasible and reproducible with minimum added complexity. Fluorescence-guided surgery may be a helpful technique for determining an appropriate total mesocolic excision in colon neoplasms. Will it provide a balance to the radical extent of the lymphadenectomy for each patient in the future?