Adequate systemic lymph node dissection is important not only for its treatment impact of better survival outcome but also for proper staging. Proper staging is crucial in clinical decision making on treatment plans and to compare treatment results among institutions and countries. Moreover， if there is an inadequate lymph node evaluation and insufficient lymph node dissection， it will result in worse survival after gastrectomy for gastric cancer patients. 

 

Near infrared (NIR) fluorescence imaging technique has emerged as visualization of vital structure intraoperatively. NIR fluorescence image after peritumoral injection of contrast agent such as ICG can visualize lymph nodes effectively despite a trace of residual contrast agent because of its high sensitivity and good depth penetration. 

 

We performed peritumoral injection of ICG before surgery to visualize every regional lymph node drained from primary tumor. We can easily identify the ICG containing lymph nodes by using NIR imaging. In this presentation， detailed our surgical procedure of ICG fluorescent-guided lymph node dissection during gastrectomy for gastric cancer will be demonstrated.