This video article presents two cases of patients with rectal cancer who underwent intraoperative lymphatic mapping using transanal indocyanine green (ICG) injection. The technique enabled real-time visualisation of lymphatic drainage patterns and directly influenced surgical decision-making during both procedures.
The first case involved a patient with a locally advanced rectal tumor where lymphatic mapping altered the planned lymphadenectomy field. In the second case, the technique confirmed lateral lymphatic spread, prompting an extended dissection approach. Both cases highlight the feasibility and clinical value of image-guided colorectal surgery using ICG.
The authors propose that transanal ICG injection may become a powerful adjunct in tailoring lymph node dissection strategies, especially in complex or high-risk cases.
