Real-time vessel navigation using indocyanine green fluorescence during robotic-assisted gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery.

Injury to the right gastroepiploic artery (RGEA) graft during gastrectomy after coronary artery bypass grafting (CABG) can cause critical coronary failure. A man in his 60s with advanced gastric cancer and a history of CABG was admitted to our hospital. His cardiac blood flow was dependent on RGEA, and a gastrectomy with RGEA preservation was necessary. Robot-assisted distal gastrectomy with real-time vessel navigation using indocyanine green (ICG) fluorescence imaging and Da Vinci Firefly technology was planned. Intraperitoneal observation revealed severe adhesions around the graft. Two milliliters ICG (2.5 mg/mL) was injected intravenously, and RGEA was visualized. An RGEA-preserving robot-assisted distal gastrectomy was successfully performed. The operation time was 279 minutes, and the blood loss was 5 mL. The postoperative course was good and there were no complications.

[1]  Japanese Gastric Cancer Association.  Japanese gastric cancer treatment guidelines 2018 (5th edition) , 2020, Gastric Cancer.

[2]  H. Arai,et al.  Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries. , 2018, The Annals of thoracic surgery.

[3]  H. Hur,et al.  Real-time Vessel Navigation Using Indocyanine Green Fluorescence during Robotic or Laparoscopic Gastrectomy for Gastric Cancer , 2017, Journal of gastric cancer.

[4]  Hideto Ito,et al.  An adequate perioperative management and strategy for gastric cancer after coronary artery bypass using the right gastroepiploic artery , 2013, Surgery Today.

[5]  H. Hirose,et al.  Twenty Years Experience With the Gastroepiploic Artery Graft for CABG , 2007, Circulation.

[6]  T. Kazui,et al.  How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature , 2007, World journal of surgical oncology.

[7]  M. Urashima,et al.  Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer , 2004, The British journal of surgery.

[8]  T. Misaki,et al.  Abdominal surgery following coronary artery bypass grafting using an in situ right gastroepiploic artery graft. , 2004, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.