Open Access Highly Accessed Research article

Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy

Yasushi Rino1*, Norio Yukawa1, Tsutomu Sato1, Naoto Yamamoto1, Hiroshi Tamagawa1, Shinichi Hasegawa1, Takashi Oshima2, Takaki Yoshikawa3, Munetaka Masuda1 and Toshio Imada4

Author Affiliations

1 Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama city 236-0004, Japan

2 Gastroenterological Center, Medical Center, Yokohama City University, Yokohama, Japan

3 Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan

4 Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan

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BMC Medical Imaging 2014, 14:18  doi:10.1186/1471-2342-14-18

Published: 22 May 2014



Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.


Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.


ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside the splenic hilum in 22 (66.7%) of the 33 patients.


ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal vessels were the major blood supply for the anastomosis in most patients.

ICG; Esophageal cancer; Blood supply route; Splenic hiatal vessels