Live surgeryApril 9, 20253:03:496 speakersAvailable in: EN / IT
ICG-Guided Laparoscopic Subtotal Gastrectomy for Antral Gastric Cancer
Live laparoscopic subtotal gastrectomy with ICG-guided D2 lymphadenectomy for antral adenocarcinoma, featuring extensive multidisciplinary technical discussion.
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Clinical case
Adenocarcinoma antrale gastrico ulcerato su area di metaplasia
Patient framing as discussed at case introduction
SexM
StagecT1-T2 N0 M0
DiagnosisAdenocarcinoma antrale gastrico ulcerato su area di metaplasia
Prior treatmentNessuno (no neoadiuvante, no resezione endoscopica)
Clinical historyAntro con metaplasia estesa, area ulcerata 6-7 cm, NIN multifocale; non candidabile a ESD né a senjorita per rischio metacrono
NotesMarcatura ICG peri-tumorale eseguita la mattina dell'intervento dall'endoscopista
Overview
First episode of the fifth edition of ICG-School, hosted by Prof. Gian Luca Baiocchi at the Hospital of Cremona. The featured procedure is a laparoscopic subtotal gastrectomy with D2 lymphadenectomy for a non-advanced antral adenocarcinoma (cT1-T2 N0), with peri-tumoral endoscopic indocyanine green marking performed the same morning by the endoscopist. The discussion, led by Gian Andrea Baldazzi, Jacopo Viganò and Lorenzo Fracasso (joining remotely), covers in detail the abdominal access (Veress vs open), trocar placement, techniques for suspending the left hepatic lobe, the standard of lymphadenectomy and the quality of ICG marking.
The episode opens with a presentation by Luigi Marino (Stryker) on the new 1788 imaging platform, which expands the laser bandwidth for new fluorophores (Cytalux, Pafolacianine), introduces 4K CSI mode and numerical quantification of ICG. During the procedure the endoscopist Roberto Grazia also intervenes to discuss marking protocols (glycerol vs saline, dosages, timing), and considerable time is devoted to organ-preserving strategies in T1 gastric cancer through a combined endoscopic-surgical procedure (LECS, sentinel-node-like), with the Cremona experience of 22 cases.
The technical portion includes considerations on energy devices (Thunderbeat, ultrasonic, radiofrequency) and management of Hem-o-lok clips, lowering of the pancreas during suprapancreatic dissection, uncut Roux-en-Y reconstruction (double loop), choice of stapler reloads and management of postoperative drainage (with reference to the Verona RIDGETRIAL). The approach to minimally invasive total gastrectomy and Azagra's near-total technique as an alternative are also discussed.
