Intraoperative navigation in robotically assisted compartmental surgery of uterine cancer by visualisation of embryologically derived lymphatic networks with indocyanine-green (ICG)

Journal of Surgical Oncology
Rainer KimmigMartin Heubner

Abstract

To evaluate feasibility of intraoperative visualization of embryologically defined organ compartments and their drainage by ICG in uterine cancer. Total of 2.5 mg of ICG have been injected into cervix or corpus in uterine cancer patients immediately prior to surgery. Green fluorescence was intermittently detected during robotically assisted laparoscopic surgery (Firefly System®, Intuitve Surgical Inc.). Total of 36 patients with uterine cancer without macroscopically suspicious nodes were evaluated with respect to their compartmental lymphatic network, collecting lymphatic vessels, and the connection to the postponed lymph basins. Müllerian (sub) compartment and transport of lymph fluid along the lymphatic collectors and connecting vessels to the postponed lymph basins could be visualized invariably in all patients. Cervix drained along the ligamentous and caudal part of vascular mesometria, whereas midcorporal and fundal drainage occurred along the upper part of vascular mesometria and along the mesonephric pathway along the ovarian vessels. Visualization of lymphatic network and downstream flow of lymphatic fluid to the postponed lymph basins by ICG is feasible; it can be used to navigate along compartment boarders for educat...Continue Reading

References

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Mar 11, 2015·The Lancet Oncology·Michael Höckel

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Citations

Sep 6, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Fabio CianchiFabio Staderini
Jul 14, 2020·Translational Biophotonics·Brent W WeyersLaura Marcu
Apr 3, 2020·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·Nadeem R Abu-RustumOliver Zivanovic
Aug 9, 2017·Annals of Surgical Oncology·Denis QuerleuNadeem R Abu-Rustum

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Methods Mentioned

BETA
hysterectomy
Fluorescence

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