Excision Of Mass Research Articles

A Case of MALToma Masquerading as a Lacrimal Caruncular Granuloma

Purpose: To report a case of mucosa-associated lymphoid tissue lymphoma (MALToma) that presented as a lacrimal caruncular granuloma.Case summary: A 38-year-old woman presented with a mass in the right lacrimal caruncle and had a history of incision and drainage. Examination revealed a 4-mm elevated mass at the lacrimal caruncle, which resembled a granuloma. The mass was excised under local anesthesia and a MALToma was diagnosed based on the histopathological examination.Conclusions: Although rare, a MALToma can present as a granuloma-like lacrimal caruncular mass. Excision and biopsy of the lacrimal caruncular mass are essential to obtain a definitive diagnosis.

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

Abstract
 Introduction & Objectives : Introduction Resection of eyelid carcinoma may lead to a risk of recurrences which might increase if excision was incomplete. Risk factors of incomplete surgical removal and recurrences are deep infiltration, spreading outside the macroscopic border, eye socket penetration, and histological type of the eyelid carcinoma. Objective To evaluate the surgical outcomes of eyelid carcinomas.
 Methods : This is a hospital based prospective observational study involving 16 patients. Prior to the surgery patients were evaluated for visual acuity, intra ocular pressure, extra ocular motility, fundus examination, and local clinical examinations. The eyelid carcinomas were histological detected concerning carcinoma type and margin involvement. Local anesthesia was applied. Patients were evaluated 1 month, 3 months and 6 months after surgery for local complications, patients satisfaction on surgical results, and recurrences. The surgical technic applied in this study were also observed.
 Results : Dominant tumor type were basal cell carcinoma and squamous cell carcinoma (87, 44%). The locations were at right and left lower eyelid with percentage of 68. 7 % and 31. 3 % respectively. All patients satisfied on surgery outcomes (100%). Three patients (6. 25 %) with complications were found within 6 months after the surgery. There were no recurrences during follow up period. Surgery procedures applied were modified hughe’s procedure (56. 25%) and mass excision and reconstruction (43. 75%).
 Conclusion : There was less complications and no recurrences within 6 months after surgery. All patients satisfied with the surgical outcomes.

Epibulbar Choristoma, Dermolipoma

Introduction : Choriostoma is a tissue anomalie distinguished by distinct cell types that are not typically present at the affected region. Dermolipoma is one type of choriostoma.
 Case Illustration : A twenty three year old woman is presented with epibulbar mass in the left eye since birth. She wished to remove the mass for cosmetic purposes. She denied any underlying medical condition and ocular history. Her visual acuity was 6/6 in both eyes and intraocular pressure was normal. Slit lamp examination revealed a yellowish white lesion of the external canthus of the left eye, no redness, and no discharge. The mass was 5 x 10 mm. Fundus examination was unremarkable. Patient underwent mass excision with cosmetic indication and has a satisfactory result.
 Discussion : A dermolipoma is an epibulbar choriostoma made of thick connective tissue and adipose tissue. The benign tumor is rare and makes up 4.2% of all conjunctival lesions. Dermolipoma can be very large, involving the extraocular muscle, lacriminal gland, and orbital tissue. Dermolipoma may be connected to epidermal nevus syndromes, Goldenhar syndrome, or coloboma. The majority of the time, these tumors don't need to be treated unless they are larger or have an unfavorable appearance.
 Conclusion : Dermolipoma is not cosmetically acceptable may be treated with excision of the mass.

Lymphoma presenting as a parapharyngeal space tumour

Among all head and neck tumours, approximately 0.5% to 0.8% localize in the parapharyngeal space, with Non-Hodgkin’s lymphomas in this region being exceptionally rare. They are documented in the literature either as isolated cases or in small case series. Here, we present a case involving a middle aged man who exhibited 4 month history of dysphagia and hoarse voice. Upon examination, showed a bulged left side of the soft palate and medialization of the pharyngeal wall. CT and MRI revealed a large lesion in the left parapharyngeal region pushing the pharynx anteromedially. Similar intensity enhancing lesion noted in nasopharynx. A transoral excision of parapharyngeal mass was performed, revealing a large B-cell non-Hodgkin’s lymphoma. Typically, parapharyngeal space tumours are benign, and surgery is the preferred treatment. Patient was transferred to tertiary care oncology hospital for further treatment. This case underscores the rarity but potential presence of extranodal non-Hodgkin’s lymphomas in the head and neck. Recognizing this pathology is crucial due to the different treatment approach it necessitates.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

(217) Revitalizing Penile Health: Advanced Surgical Approach for Treating Penile Mass Formation Resulting from Neglected Fractures, Enhanced with Pericardial Graft Reinforcement

Abstract Introduction Penile fractures are rare but serious emergencies caused by the rupture of the tunica albuginea during sexual activity. Prompt medical attention is crucial to prevent complications like erectile dysfunction, penile curvature, and hematoma. Delayed reporting due to embarrassment or fear can lead to further complications. Diagnosing penile fractures primarily relies on clinical examination, and treatment options depend on the timing of presentation. Seeking immediate medical help is vital to prevent long-term complications and ensure proper management. Objective To emphasize the importance of early medical attention and surgical intervention in the context of penile fractures, with the aim of preventing or reducing the occurrence of long-term complications. Methods This case report involves a 55-year-old male who experienced a penile fracture during intercourse. Initially, he had no hematoma, bruising, pain, or loss of erection. Two weeks later, he sought medical advice due to a penile bump and slightly painful erections. He was managed conservatively with ice, nonsteroidal anti-inflammatory medications, and abstinence from intercourse. Two months later, he presented to our clinic with complaints of a penile mass and curvature, affecting his erections and penetration. A penile Doppler ultrasound revealed a fibrotic hematoma with a complex cystic lesion measuring 23.1 mm × 18.1 mm × 28.3 mm on the right lateral mid-penile shaft. The patient underwent complex penile mass excision, tunica albuginea plication, and pericardium graft reinforcement. During the surgery, scar tissue and underlying fibrotic hematoma were removed (Figure 1). A complex cystic lesion on the right lateral mid-penile shaft was also excised (Figure 2). A tunica albuginea plication corrected the 30° left dorsal curvature. A pericardium graft (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) reinforced the weakened tunica albuginea and covered the defect (Figure 3). Histopathology of the mass reported “a penile fibrotic mass, measuring 2 cm × 1.8 cm × 2.6 cm with an irregular dark brown firm cystic structure filled with yellow-tan necrotic tissue.” Microscopic description showed “a fibrous capsule with central hemorrhage and fibrin.” Results The patient had a successful procedure and smooth recovery. At 6- and 9-month follow-up, he expressed satisfaction with no complications or long-term side effects. Erectile function was restored, and penile curvature resolved, enabling satisfactory penetrative intercourse. Surgical treatment is recommended for achieving satisfactory results and restoring sexual function in penile fractures. Various graft materials can be used to reinforce penile defects. Tutoplast® (processed allograft tissue from cadaveric pericardium) has shown excellent results in Peyronie's curvature repair, but the efficacy of bovine pericardium remains uncertain. In this case, Tutoplast® was chosen for its accessibility and the surgeons' expertise in Peyronie's repair and penile prosthesis implantation, ensuring the best possible outcome. Conclusions This case report highlights fibrotic hematoma due to delayed penile fracture presentation, managed through mass excision and curvature correction. Currently, there is no literature available that discusses fibrotic hematoma formation from delayed penile fractures. Prompt medical attention crucial to avoid long-term complications. Early surgical management prevents erection loss, curvature, hematoma, or mass formation, improving quality of life for patients with penile fractures. Disclosure No.

A novel application of the Hyperflex™ tracheostomy tube for lung isolation in a patient with airway stoma after laryngectomy.

In patients who have undergone laryngectomy followed by permanent tracheostomy, managing the airway for one-lung ventilation during lung surgery may present a challenge for anaesthetists. This case report discusses a 45-year-old man with a permanent tracheostomy after a laryngectomy performed for laryngeal carcinoma 5 years ago. He was scheduled to undergo excision of a right bronchial mass for which one-lung ventilation was required. An adjustable Flange Hyperflex™ Tracheostomy tube (Bivona® Silicone Tracheostomy tube, Smiths Medical ASD, Inc., Gary, Indiana, USA) was used for this purpose and the tube was guided into the left main bronchus with a bronchoscope. Appropriate lung isolation was achieved using this technique, and there were no airway-related complications during or after the surgery. This case report shows that a Hyperflex™ tracheostomy tube can be successfully utilised in challenging airway scenarios in patients with a tracheostomy, where other options may not be feasible.

Liver mass masquerading as adrenal space-occupying lesion: A rare presentation

Adrenal pseudotumors have been described in the literature; however, liver mass masquerading as adrenal space occupying lesion is a rare entity. Here, we describe the case of a 40-year-old female who presented with right-sided abdominal pain for 1 year and was provisionally diagnosed as non-functioning adrenal adenoma after evaluation. She was planned for laparoscopic adrenalectomy. On laparoscopy, a mass arising from the liver was found. The procedure was abandoned and a computed tomography-guided tru-cut biopsy of liver mass was done, which showed the feature of benign liver tissue suggestive of hepatic adenoma. Later, she underwent an excision of the liver mass. Adrenal pseudotumor should always be kept in mind during surgery for any suspected adrenal mass.

18 F-FDG PET/CT Findings of Ovarian Myxoid Chondrosarcoma.

Ovarian myxoid chondrosarcoma is a rare and aggressive tumor. We present 18 F-FDG PET/CT findings of ovarian myxoid chondrosarcoma. The images not only demonstrated a pelvic mass with increased FDG uptake, but also a mass with increased FDG uptake in the right lower abdominal wall. Ovarian malignancy with abdominal wall metastases was suspected. An extraskeletal myxoid chondrosarcoma was diagnosed histopathologically after the mass excision.

Blood within the bone: orbital intraosseous venous malformation

ABSTRACT Purpose Description of clinical features, radiological characteristics, and management strategies in primary orbital intraosseous venous malformation (OIVM) with pertinent literature review. Methods A retrospective analysis including clinical, radiologic, operative, and histopathological data of six cases of histopathologically proven OIVM was done. A comprehensive literature review was conducted using online databases and augmented with manual search to identify reported cases of OIVM. Results Study data showed five females and one male in young to middle-age group, with an average age of 30 years (range: 20–48 years). Proptosis was noted in five cases (83.33%), and the duration of symptoms ranged from 6 months to 10 years. Frontal and zygomatic bones were most frequently affected and expansile bony lesion was the most common CT scan finding. Three patients underwent pre-operative embolization of feeders followed by en bloc excision of mass and surgical reconstruction (50%); one patient was managed with partial excision (16.66%) while two were regularly followed-up after incision biopsy (33.33%). Histopathology revealed vascular spaces with endothelial lining, separated by bony trabeculae in all patients. Follow-up periods ranged from 6 to 48 months and no recurrence or progression were noted. Conclusions OIVM is an exceptionally rare disorder with a gradually progressive benign course. Ophthalmologists need to be mindful of this entity during patient evaluation as it has propensity for large volume blood loss intra-operatively, owing to its vascular nature. Complete excision with reconstruction of resultant defect is the preferred treatment strategy and without known recurrence.

Vulval Leiomyoma: A Case Report

Vulval leiomyoma is a rare condition and usually misdiagnosed, with only a few cases reported till now. A 38 years old women presented with painful mass over right labia majora. Pelvic examination showed redness and swelling over right labia. An 8 x 5 cm mass of firm consistency was found near vestibule, extended above up to lower one third of vagina causing discomfort at the perineum. She had complete excision of mass. Mass sent for histopathology. Post-operative histopathology confirmed the diagnosis of vulval leiomyoma.

Vocal Fold Paresis and Voice Outcomes following Vocal Fold Mass Excision.

To correlate the surgical results of vocal fold mass excision with pre-operative existence of vocal fold paresis. Data were collected on 66 patients who underwent excision of benign vocal fold masses from 2015 to 2020. The pre- and post-operative strobovideolaryngoscopy (SVL) examinations for all patients included were evaluated blindly by three otolaryngologists using THE Voice-Vibratory Assessment with Laryngeal Imaging (VALI) Form for scar severity, mucosal wave, free edge contour, glottal closure, and phase closure. The success of mass excision surgery was determined based on the presence of the following criteria post-operatively: 1) improved mucosal wave motion 2) improved phase closure or glottic closure 3) improved free edge contour and 4) lack of worsening of vocal fold scar severity. Surgery was considered successful if 3 or 4 criteria were met, partially successful if 1 or 2 criteria were met, and unsuccessful if no criteria were met. The percent recruitment of the thyroarytenoid, posterior cricoarytenoid (PCA), and cricothyroid muscles were used evaluated the severity of paresis as mild (70-99% recruitment), moderate (40-60% recruitment), or severe (0-39% recruitment). VHI-10 scores were used as subjective measures of pre- and post-operative voice. Sixty-six patients (26 male, 40 female) were included in this study, with a mean age of 37.25 ± 16.6 (range 18-78). Twelve patients had no evidence of VF paresis noted during the initial clinical evaluation; and 52 patients had paresis and had undergone laryngeal EMG. 81% of these patients had mild paresis, 12.8% had moderate paresis, and 5.8% had severe paresis. Based on pre- and post-operative strobovideolaryngoscopy, there was improvement in mucosal wave in 44.9% of cases, improvement of phase or glottic closure in 85.4% of cases, improved free edge contour in 95.5% of cases, and worsening of scar in 38.5% of cases. 39.6% of surgeries were fully successful, 33.3% of surgeries were partially successful, and 27.1% were not successful. There was a significant correlation between female gender and vocal fold paresis (P=0.048). Paresis severity did not correlate with complete or partial surgical success (P=0.956), pre-operative VHI-10 scores (P=0.519), post-operative VHI-10 scores (P=0.563), or strobovideolaryngoscopy parameters. Unilateral and bilateral paresis did not correlate with any other parameter of surgical success (P >0.05). This study suggests that there is no correlation between pre-operative vocal fold paresis and voice outcomes after mass excision surgery, that the majority of mass excision surgeries (72.9%) are successful based on improvement in stroboscopic parameters, and that the proportion of patients with moderate and severe paresis is consistent across all laryngeal nerves.

Intramedullary mature teratoma in an adult: A case report

Abstract Intraspinal mature teratomas rarely occur in adults. There is little published information about the diagnosis and prognosis of adult-onset intradural spinal teratoma due to its rarity. We describe a rare case of adult intramedullary mature teratoma. A 36-year-old woman presented with complaint of a long-standing low back pain accompanied by progressive numbness of the lower extremities for a month. Magnetic resonance imaging (MRI) revealed an intramedullary tumor extending between T11 and L3. Gross excision of mass was performed with no complications. Patient symptoms improved over time and she is still under follow-up. Intramedullary mature teratoma in adults is rare but reports suggest an increase in recent years. These tumors manifest themselves based on their location within the spinal cord and the affected surrounding nerve roots. MRI is the most helpful imaging modality. But definitive diagnosis is accomplished by histopathological examination. Surgical resection is the preferred treatment. For pure mature teratomas, gross resection is comparable with radical resection. In general, prognosis for these tumors is good, with most patients showing improved neurological status or stability after resection.

Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial.

Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol. Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated. On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group. We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions. Level I, randomized controlled trial.

An Unusual Presentation of Low-grade Chondrosarcoma of the First Metatarsal Bone requiring extensive Resection: A Case Report

Chondrosarcoma (CS) is one of the common malignant bone tumours arising from chondrocytes with variable degrees of malignancy. It is mainly noted in flat bones like the pelvis and scapula, and sometimes in long bones like the proximal femur. This case report describes a 40-year-old female who presented with pain over her right great toe for six months and swelling for four months. An open biopsy revealed low-grade CS. Subsequently, the patient underwent amputation of the first ray till the tarsometatarsal joint with meticulous dissection of the tumour mass. At eight years of follow-up, the patient had no recurrence and no functional disability. Therefore, in cases of low-grade CS, first ray amputation along with excision of the tumour mass helps avoid recurrence and metastasis, providing a satisfactory functional outcome.

Primary Monophasic Omental Synovial Sarcoma in Nulliparous Female: A Case Report

Synovial Sarcoma (SS) is an uncommon soft-tissue malignancy that primarily occurs near tendon sheaths and bone joints. Its primary intra-abdominal location is infrequent and characterised by non specific clinical signs. The mainstay of treatment remains wide local excision with negative margins. Hereby the authors report a rare case of monophasic omental SS in a 30-year-old nulliparous female who presented with chief complaints of an enlarging lump in the right abdominopelvic region over the past year and constipation for three months. The mass was non mobile and non tender. The rest of the physical and laboratory examinations were normal. She has a history of diagnostic laparoscopic excision (for the same complaint) of bilateral adnexal masses with right salpingectomy done three months ago in an outside set-up where histopathology diagnosed the mass as a low-grade fibromyxoid tumour. Presently, Contrast- enhanced Magnetic Resonance Imaging (CEMRI) revealed a large lobulated heterogeneous mass of 19.5×15.4×20 cm extending into mesorectal fat and encasing the sigmoid colon, rectosigmoid junction, uterus, and bilateral ovaries. The patient was taken for emergency surgery as she started displaying symptoms of acute obstruction. Debulking surgery (R2 resection) with ileostomy was performed. Histopathology and immunohistochemistry confirmed the diagnosis of monophasic SS. The patient was started on doxorubicin and has completed three cycles of chemotherapy. SS is an infrequent entity with high mortality rates. The main course of treatment is surgery with healthy resection margins. Long-term follow-up is required due to the high recurrence rate.

Massive Transfusion in a Patient Undergoing Elective Excision of Retroperitoneal Mass

ABSTRACT Massive intraoperative blood loss requires expectant measures, efficient coordination among providers, and timely feedback to optimize outcomes. In the Philippines, case reports on massive blood loss and transfusion are lacking. This report describes a 67-year-old female who underwent elective adrenalectomy, nephrectomy, and hepatic resection, with a total intraoperative blood loss of 20 L in a 13-h surgery. Efficient conduct of the institution’s massive transfusion protocol, multiple pressor support, electrolyte and glucose correction, and anticipatory management of associated complications of hypovolemia and transfusion were important elements of successful management. The patient tolerated the surgery and was discharged well after 12 days. In the absence of more sophisticated monitoring and management options in a low-resource setting, maximizing available means and anticipatory interventions is key.

Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day Results.

Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery. In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study. In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period. Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.

A rare case of synovial chondromatosis of the foot

Background: Synovial chondromatosis is a benign rare condition affecting synovial tissue. It has a preference for males with a ratio of 2:1. Also, synovial chondromatosis has a prevalence of 1 in 100,000. Initially, it starts asymptomatically then develops pain, and swelling with or without a restricted range of motion as the disease progresses. In addition, the imaging options are an x-ray and then an MRI. To confirm the diagnosis, a biopsy with histopathologic evaluation is needed. Finally, conservative management options are NSAIDs and intraarticular steroids. Surgery is considered after the failure of conservative management. Case Presentation: A case of synovial chondromatosis of the left foot in a 37-year-old female with no prior medical or surgical history was presented. The patient came with no signs or symptoms and was admitted as a case of elective mass excision. Histopathologic evaluation of the mass confirmed the diagnosis of synovial chondromatosis. Initially, perioperative spinal anesthesia was performed. After the patient had been sedated, a vertical incision directly over the dorsolateral aspect of the foot, over the lesion, was made. Subsequently, a lateral incision and a midline horizontal incision at a 90-degree angle to the initial surgical incision were made. Finally, the mass was excised completely with no remnants. Conclusion: Synovial chondromatosis is a frequently sub-diagnosed disease and has not been fully understood, so proper clinical evaluation ought to be done earlier for better outcomes.

Indocyanine Green (ICG) Fluorescence-Assisted Open Surgery Using the Rubina® Lens System in the Pediatric Population: A Single-Center Prospective Case Series.

There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina® Lens system. All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina® Lens for ICG fluorescence visualization. A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports. Based on this initial experience, FGS using the Rubina® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.