Multimodal Use of Fluorescent Imaging in Colorectal Cancer Surgery

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This video vignette shows innovative and expanded applications of fluorescent imaging by using indocyanine green to guide and increase the precision of colorectal cancer surgery. The work goes beyond showing perfusion, demonstrating fluorescent imaging in novel ways, including tumor localization in emergent situations, highlighting of the sentinel lymph node chain, and mapping out the lymphatic drainage of colonic tumors to guide more accurate oncologic resections. In light of the current debate regarding the need for an extended lymphadenectomy and complete mesocolic excision in colon cancer, this technology could offer value through real-time visualization of the tumor’s lymphatic drainage map, sentinel lymph nodes, and any aberrant nodes, providing the surgeon with the optimal resection margins to perform more precise oncologic resections. Although further validation is needed, using this technology to guide more precise resections could obviate the need for radical, extended mesenteric resections and their associated morbidity. Seeing these capabilities, studies are underway to validate and standardize best practices for the ideal concentration, injection site, timing for injection, and timing to monitor lymphatic spread to further this tool for precision surgery. See Video at

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