This composite figure illustrates the circulatory network of a subtotal stomach (SS) during reconstructive surgery using indocyanine green (ICG) fluorescence imaging. The panel consists of three intraoperative clinical photographs and one anatomical diagram. The ICG fluorescence images demonstrate a vibrant, dense, and interconnected vascular network beneath the gastric mucosa, indicating robust perfusion. Key arterial landmarks are labeled: the Right Gastric Artery (Rt. GA) is visible along the lesser curvature, and the Right Gastro-Epiploic Artery (Rt. GEA) is identified along the greater curvature. These primary vessels and their preserved arteriovenous arcades exhibit high-intensity fluorescence, branching into a complex capillary bed that ensures uniform tissue viability up to the tip of the gastric conduit. The anatomical diagram correlates these fluorescent findings with the surgical anatomy, highlighting the vascular supply (red) and the longitudinal orientation of the subtotal stomach. This imaging modality serves as an intraoperative tool for real-time assessment of blood flow, which is critical for minimizing anastomotic complications in esophageal or gastric reconstruction.

This composite figure illustrates the surgical creation of a gastric conduit for urinary diversion. Panel A is an anatomical diagram showing the stomach and the vascular supply of the greater curvature, specifically the gastroepiploic artery. A blue double-headed arrow and text indicate the 11-cm longitudinal section along the greater curvature targeted for conduit formation, starting approximately 2 cm proximal to the pylorus. Panel B is an intraoperative clinical photograph providing a surgical view of the mobilized gastric conduit. The conduit appears as a pinkish-red, vascularized tubular structure. A surgical ruler is held by a gloved hand alongside the tissue, confirming a length of approximately 11 cm. The conduit maintains its blood supply from the right gastroepiploic artery to ensure viability for subsequent ureterogastric anastomosis. This material demonstrates a specialized reconstructive technique used in complex pelvic surgeries, such as total pelvic exenteration, where standard urinary diversion methods like an ileal conduit may not be feasible.

This clinical intraoperative photograph displays the macro-anatomical features of the stomach during an abdominal surgical procedure. The stomach is oriented with the cranial aspect (head) toward the left of the frame. Key anatomical landmarks are identified: the lesser curvature is indicated by a long solid arrow on the concave side, while the greater curvature is marked by a short arrow on the convex side. A distinct angular notch (incisura angularis) is visible along the lesser curvature, denoted by a dashed arrow, serving as a boundary between the gastric body and the pyloric part. The pylorus itself is marked with an asterisk (*). A gastric lymph node is localized along the lesser curvature, indicated by an arrowhead. The stomach's surface exhibits a rich vascular network of branching blood vessels. Surrounding visceral structures, including liver lobes and intestinal segments, are visible within the surgical field, which is maintained by retractors and surgical gauze. This image serves as an educational reference for gastric anatomy, vascularization, and landmark identification during laparotomy.

This diagnostic image shows intraoperative indocyanine green (ICG) fluorescence angiography using a photodynamic eye (PDE) system to visualize blood flow in a reconstructed stomach conduit. The image demonstrates the 'greater curvature route' of arterial supply. Visible anatomical structures include the left gastroepiploic artery in the superior field and the right gastroepiploic artery in the inferior field, both appearing as relatively thick, high-intensity curvilinear signals. Connecting these two major vessels is a network of greater curvature vessels, which exhibit a more tortuous, meandering, and complex branching pattern. The clinical significance of this imaging is to evaluate the microcirculation and perfusion of the gastric graft during esophageal cancer surgery, ensuring the viability of the conduit's fundus and anastomotic site. This technique helps surgeons identify collateral pathways and the 'greater curvature route' to prevent postoperative complications like anastomotic leakage or conduit necrosis.