Ml Of Indocyanine Green Research Articles

Key issues in diagnostic accuracy of sentinel lymph node biopsy in early-stage ovarian cancer: systematic review and meta-analysis

ObjectiveSentinel lymph node (SLN) mapping may reduce the morbidity of lymphadenectomy while maintaining diagnostic accuracy. Nevertheless, SLN mapping in epithelial ovarian cancer is still under investigation. This systematic review and...

Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients.

Application of indocyanine green (ICG) fluorescence has led to new developments in gastrointestinal surgery. However, little is known about the use of ICG for the diagnosis of postoperative gut leakage (GL). In addition, there is a lack of rapid and intuitive methods to definitively diagnose postoperative GL. To investigate the effect of ICG in the diagnosis of anastomotic leakage in a surgical rat GL model and evaluate its diagnostic value in colorectal surgery patients. Sixteen rats were divided into two groups: GL group (n = 8) and sham group (n = 8). Approximately 0.5 mL of ICG (2.5 mg/mL) was intravenously injected postoperatively. The peritoneal fluid was collected for the fluorescence test at 24 and 48 h. Six patients with rectal cancer who had undergone laparoscopic rectal cancer resection plus enterostomies were injected with 10 mL of ICG (2.5 mg/mL) on postoperative day 1. Their ostomy fluids were collected 24 h after ICG injection to identify the possibility of the ICG excreting from the peripheral veins to the enterostomy stoma. Participants who had undergone colectomy or rectal cancer resection were enrolled in the diagnostic test. The peritoneal fluids from drainage were collected 24 h after ICG injection. The ICG fluorescence test was conducted using OptoMedic endoscopy along with a near-infrared fluorescent imaging system. The peritoneal fluids from the GL group showed ICG-dependent green fluorescence in contrast to the sham group. Six samples of ostomy fluids showed green fluorescence, indicating the possibility of ICG excreting from the peripheral veins to the enterostomy stoma in patients. The peritoneal fluid ICG test exhibited a sensitivity of 100% and a specificity of 83.3% for the diagnosis of GL. The positive predictive value was 71.4%, while the negative predictive value was 100%. The likelihood ratios were 6.0 for a positive test result and 0 for a negative result. The postoperative ICG test in a drainage tube is a valuable and simple technique for the diagnosis of GL. Hence, it should be employed in clinical settings in patients with suspected GL.

Laparoscopic Indocyanine Green-Guided Sentinel Lymph Node Biopsy for Gallbladder Neoplasms.

Surgical resection, the only potentially curative treatment for gallbladder cancer (GBC), entails an extended cholecystectomy with portal lymphadenectomy. Lymph node dissection is a key staging procedure, but its therapeutic value is unclear. Additionally, it is technically challenging and potentially harmful. Methods for better assessment of lymph node status are needed. This report presents a case of indocyanine green (ICG)-guided sentinel lymph node biopsy (SNLB) for a patient with a gallbladder mass suspicious for GBC. An 81-year-old woman consulted for abdominal discomfort. Abdominal ultrasound showed an intraluminal gallbladder mass suspicious for GBC. Staging imaging did not show liver invasion, lymphadenopathy, or distant metastasis. Given the woman's advanced age and limited extent of disease, a laparoscopic extended cholecystectomy with an ICG-guided SLNB was performed. Injection of 1 ml of ICG (0.125 mg/mL) into the gallbladder bed was performed using a 22-gauge needle, avoiding direct injection into the gallbladder wall. A near-infrared camera was used to visualize real-time ICG flow through the lymphatic vessels of the gallbladder toward the cystic node. Then, a sentinel lymph node posterolateral to the bile duct (station 12b) was identified. The node was resected and sent for permanent section. The procedure continued with an extended cholecystectomy. Pathology showed an intracholecystic papillary neoplasm with high-grade dysplasia. Cystic and sentinel lymph nodes were negative for malignancy. For patients with gallbladder neoplasms, ICG-guided SLNB is a feasible technique that could allow for treatment de-escalation. Further evaluation in clinical trials is needed.

Cannulation Indocyanine Green Method for Strategic Management of Postoperative Arterial Thrombosis after Free Jejunal Flap Transfer

Summary: Indocyanine green (ICG) angiography is widely used in reconstructive surgery to confirm the perfusion of the flap. Here, we report a case in which the use of the “cannulation ICG method” was useful for strategic management of postoperative arterial thrombosis after free jejunal flap transfer. A 64-year-old woman underwent cervical esophagectomy followed by a free jejunal transfer. On postoperative day 3, ischemia of the free jejunum was suspected, and takeback was performed. In the reoperation, re-anastomosis of the artery was planned after the removal of arterial thrombus. However, before re-anastomosis, it was unclear whether there was venous thrombus and whether this jejunum flap was salvageable. To resolve these two questions, we performed the cannulation ICG method. In this method, we injected a mixture of 1.0 mL of ICG and 20 mL of blood into the jejunal artery via 24-gauge cannula. We then evaluated the perfusion of the jejunal flap and monitoring jejunum, and the patency of the venous anastomosis site using a near-infrared fluorescence imaging device (LIGHTVISION; Shimadzu Corporation, Kyoto, Japan). In this case, the whole jejunal flap (including the monitoring jejunum) and venous anastomosis site were highlighted. We determined that there were no venous thrombi and that the entire jejunum was salvageable. After the arterial re-anastomosis, ICG angiography showed good perfusion of the whole jejunum. The postoperative course was uneventful, and the free jejunal flap survived completely. The cannulation ICG method may be effective for determining the surgical method for reoperation due to arterial thrombosis after reconstruction of the free jejunum.

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

BackgroundLymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for the intraoperative prediction of lymph node metastasis in esophageal or esophagogastric junction cancer. However, a consistent method that yields sufficient diagnostic quality is yet to be confirmed. This study explored the diagnostic utility of our newly established lymphatic flow mapping protocol for predicting lymph node metastasis in patients with esophageal or esophagogastric junction cancer.MethodsWe injected 0.5 mL of ICG (500 μg/mL) into the submucosal layer at four peritumoral points on the day before surgery for 54 patients. We performed lymphatic flow mapping intraoperatively using NIR imaging. After determining the NIR status and presence of metastases, evaluable lymph node stations on in vivo imaging and all resected lymph nodes were divided into four categories: ICG+meta+ (true positive), ICG+meta− (false positive), ICG−meta+ (false negative), and ICG−meta− (true negative).ResultsThe distribution of ICG+ and meta+ lymph node stations differed according to the primary tumor site. Sensitivity and specificity for predicting meta+ lymph nodes among ICG+ ones were 50% (95% CI 41–59%) and 75% (73–76%), respectively. Predicting meta+ lymph node stations among ICG+ stations improved these values to 66% (54–77%) and 77% (74–79%), respectively. Undergoing neoadjuvant chemotherapy was an independent risk factor for having meta+ lymph nodes with false-negative diagnoses (odds ratio 4.82; 95% CI 1.28–18.19). The sensitivity of our technique for predicting meta+ lymph nodes and meta+ lymph node stations in patients who did not undergo neoadjuvant chemotherapy was 79% (63–90%) and 83% (61–94%), respectively.ConclusionOur protocol potentially helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer undergoing esophagectomy who did not undergo neoadjuvant chemotherapy.Graphical abstract

164. INTRAOPERATIVE LYMPHATIC FLOW MAPPING USING INDOCYANINE GREEN PREDICTS LYMPH NODE METASTASIS IN ESOPHAGEAL CANCER PATIENTS NOT TREATED WITH NEOADJUVANT CHEMOTHERAPY

Abstract Background Lymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for the intraoperative prediction of lymph node metastasis (LNM) in various cancers. Previous studies examined the feasibility of applying this technique to patients with esophageal cancer. However, a consistent method that yields sufficient diagnostic quality has yet to be confirmed. This study explored the diagnostic utility of our established lymphatic flow mapping protocol for predicting LNM in esophageal cancer. Methods We injected 0.5 mL of ICG (500 μg/mL) into the submucosal layer at four peritumoral points on the day before surgery for 54 patients. We performed lymphatic flow mapping intraoperatively using NIR imaging. After determining the NIR status and presence of metastases, evaluable lymph node stations on intraoperative NIR imaging and all resected lymph nodes were divided into four categories: ICG + meta+ (true positive), ICG + meta− (false positive), ICG − meta+ (false negative), and ICG − meta− (true negative). Logistic regression models were used to investigate the characteristics of patients with LNs or LN stations associated with high false-negative rates. Results The distribution of ICG+ and meta+ lymph node stations differed according to the primary tumor site. Sensitivity and specificity for predicting meta+ lymph nodes among ICG+ ones were 50% and 75%, respectively. Predicting meta+ lymph node stations among ICG+ stations improved these values to 66% and 77%, respectively. Undergoing neoadjuvant chemotherapy was an independent risk factor for having meta+ lymph nodes with false-negative diagnoses (odds ratio: 4.82; 95% confidence interval: 1.28–18.19). The sensitivity of our technique for predicting meta+ lymph nodes and meta+ lymph node stations in patients who did not undergo neoadjuvant chemotherapy was 79% and 83%, respectively. Conclusion Our NIR imaging protocol potentially helps to predict lymph node metastasis intraoperatively in patients with esophageal cancer undergoing esophagectomy who had not undergone neoadjuvant chemotherapy. This technique may effectively serve as a parameter for assessing the need for dissecting LNs in each station and determining whether it is applicable to reduce the extent of lymphadenectomy.

V11-08 APPLICATION OF INDOCYANINE GREEN ANGIOGRAPHY IN ROBOTIC MICROSURGICAL VARICOCELECTOMY

You have accessJournal of UrologyCME1 Apr 2023V11-08 APPLICATION OF INDOCYANINE GREEN ANGIOGRAPHY IN ROBOTIC MICROSURGICAL VARICOCELECTOMY Sarah Brink, Nathan Cheng, and David Shin Sarah BrinkSarah Brink More articles by this author , Nathan ChengNathan Cheng More articles by this author , and David ShinDavid Shin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic microsurgical varicocelectomy has emerged as a feasible alternative compared to the traditional operating microscope due to enhanced visualization, improved ergonomics, and the utilization of indocyanine green (ICG) for testicular artery identification and preservation. ICG angiography (ICGA) provides clear visualization of the artery; has fast onset and offset; is less time-intensive, more objective, and less expensive than the microvascular Doppler; and can be used for documentation purposes. In this video, we demonstrate the use of ICGA both for arterial identification and for confirmation of patency at the conclusion of the case. METHODS: Our institution performs varicocelectomies via the robotic microsurgical approach. The spermatic cord is first identified and isolated through a subinguinal incision, then the Da Vinci robot is docked extracorporeally. The cremasteric fibers are divided and the external spermatic fascia is entered. The vas deferens is isolated and preserved with a vessel loop. After ligation of superficial veins, ICGA is utilized to visualize the testicular artery. One ml of ICG (2.5 mg/ml) is injected intravenously for identification of the artery. The varicocelectomy is completed, then an additional 1 ml of ICG is injected intravenously to confirm arterial patency. RESULTS: ICGA successfully identifies the testicular artery within 30 seconds and is washed out within 1 minute, allowing for multiple administrations throughout the procedure, including confirmation of arterial patency at the conclusion of the case. Due to the clear visualization of arterial blood supply with ICGA, picture and/or video may be taken and preserved for documentation of arterial patency after the varicocelectomy is completed. CONCLUSIONS: Due to the complexity of vascular anatomy within the spermatic cord, distinguishing arteries from veins may be challenging and time-intensive when using a Doppler ultrasound probe alone during microsurgical varicocelectomy. ICG is an excellent tool in robotic microsurgical varicocelectomy, assisting in identification of the testicular artery and in demonstrating patency of the artery after the varicocelectomy is completed, without adding significant time or complication. Further studies are needed to assess if ICGA alone can be used for identification and confirmation of arterial blood supply during robotic microsurgical varicocelectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Brink More articles by this author Nathan Cheng More articles by this author David Shin More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of indocyanine green systemic administration for bile leak detection after hepatectomy: a protocol for a prospective single-arm clinical trial with a historical control group

IntroductionBile leakage (BL) after hepatectomy cannot always be detected with conventional methods; moreover, BL cannot be completely prevented. Recently, navigation procedures with indocyanine green (ICG) have been reported. Furthermore, we...

Real-time Navigation for Vascularized Lymph-node Transplantation Using Projection Mapping with Indocyanine Green Fluorescence.

The medical imaging projection system (MIPS) is a real-time surgical navigation device using indocyanine green (ICG) emission signals and active projection mapping. The difference between the object and the projected image is within 1 mm, and the time lag is within 0.1 seconds. We herein report the application of the MIPS to vascularized lymph-node transplantation (VLNT) surgery for lower extremity lymphedema to detect inguinal lymph nodes and perform color-coded navigation surgery for lymph-node resection. A left superficial inguinal lymph node was planned to be used as a donor for VLNT to the right lower leg in a 73-year-old woman with lower extremity lymphedema. Under general anesthesia, multiple intradermal injections of 0.1 ml of ICG were administered around the left inguinal donor site. The MIPS showed a clear linear projection image from a lateral injected point connecting to a lateral superficial inguinal lymph node. The left superficial circumflex iliac artery and vein were dissected for vascularized VLNT. Intraoperative real-time MIPS navigation continuously guided the transection plane colored by ICG fluorescence signals without shifting the visual focus from the surgical field. This is the first report of the intraoperative use of ICG projection mapping for VLNT donor-site surgery. The MIPS was able to visualize functional lymph nodes to facilitate minimally invasive donor-site surgery.

Anastomotic leak test using indocyanine green during laparoscopic Roux-en-Y gastric bypass: A cohort study.

Indocyanine green (ICG) can be injected into the human bloodstream and it allows us to show stomach vascularity in real time. The aim of our study is to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic Roux-en-Y Gastric Bypass (RYGB in our center and how the perfusion of the gastro-jejunal anastomosis affects the onset of fistula. 30 consecutive patients underwent RYGB with ICG fluorescence angiography at our center from January 2020 to December 2021.5ml of ICG were then injected intravenously to identify the blood supply of the stomach and the gastro-jejunal anastomosis. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05476159 for the Organization UFoggia. In the RYGB tested with ICG, we all have adequate perfusion but despite this a methylene blue test was positive and allowed us to reinforce the suture of the gastro-jejunal anastomosis. Intraoperative ICG testing during laparoscopic RYGB may be helpful in determining which patients are at an increased risk for leakage but multiple factors concur to the pathophysiology and the incidence of gastric fistula not only the perfusion.

Pivotal role of injection volume on sunken cheek prevention in masseter muscle BoNT-A injection: A cadaver study.

Botulinum neurotoxin A injection is a popular noninvasive alternative for the treatment of masseter hypertrophy. This study was conducted to identify a safe injection volume to avoid sunken lateral cheek after botulinum neurotoxin A injection in the masseter muscle. One milliliter or 0.5ml of indocyanine green was randomly injected into either side of the masseter muscles of 18 fresh cadaver heads. The bilateral spreads of indocyanine green within the masseter were observed by a fluorescence imager. The masseters were then dissected, and the spreading distance was measured. Dye spreading showed an oval shape parallel to the long axis of the masseter muscle. The lower edges of the masseters were all stained with indocyanine green. The upward spreading exceeded the mouth corner-tragus line in 94.44% (17/18) of the masseters on the 1-ml side, and 11.11% (2/18) of the masseters on the 0.5-ml side. The spreading area and upward spreading distance on the 1-ml side (9.95±0.48cm2 , 3.18±0.31cm) were significantly larger than the 0.5-ml side (7.13±0.80cm2 , 2.08±0.32cm). The spread of indocyanine green within the masseter occurs in direct proportion to its volume. A bolus of 1ml easily exceeded the mouth corner-tragus line and cause sunken cheek.

Feasibility of sentinel lymph node detection by near-infrared endoscopy in squamous cell carcinoma of the oral cavity: a pilot study.

Near-Infrared (NIR) fluorescence imaging is a novel technique for intraoperative sentinel lymph node (SLN) identification. It has demonstrated promising results in several surgical specialties. The study aims to evaluate the feasibility of identifying the SLN by indocyanine green (ICG) enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC). Seven patients with (cT1-3 N0) OCSCC were included. We injected 1-1.25 ml of ICG (5 mg/ml) at four to five points around the primary. After the elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken via IMAGE1 STM NIR/ICG system to define the SLN(s). We sampled fluorescence marked SLN(s) stratified to lymph node levels, followed by level-specified elective neck dissection. The detection of at least one unilateral or bilateral SLN (range 1-5) was possible in every case. The fluorescence signal occurred, on average, 5.0 ± 2.2 minutes after injection. A total of 22 SLN could be identified. Among 331 histologically examined lymph nodes we could detect one micrometastasis, which was correctly defined as SLN (1/22). There were no false-negative findings. No adverse reactions to ICG occurred. Our first results are indicating the concept of SLN concerning OCSCC after the application of real-time NIR fluorescence endoscopy. However, this has to be verified by more extended studies.

Laparoscopic anatomical liver resection guided by real-time indocyanine green fluorescence imaging: experience and lessons learned from the initial series in a single center.

Anatomical liver resection is an established procedure for primary hepatic tumors. Laparoscopic anatomical hepatectomy has been proven to be technically achievable from S1 to S8 in experienced hands. The indocyanine green (ICG) fluorescence imaging technique offers a novel tool of intraoperative visualization in hepatobiliary surgery. This study aims to investigate the feasibility of laparoscopic anatomical liver resection based on segmental staining using real-time ICG fluorescence. From December 2015 to October 2017, 36 patients in our institute underwent lap-ALR using real-time ICG fluorescence mapping of the tumor-bearing portal territory. The procedural and perioperative data were collected and analyzed. In our case series, we successfully performed the fashion of positive staining mostly in segmentectomy or sub-segmentectomy by individually injecting 5-10ml of ICG (0.025mg/ml) into its feeding portal branch guided by intraoperative ultrasound, and the negative staining mainly for sectionectomy, hemihepatectomy and multi-segmentectomy by interrupting the Glissonean pedicle serving the tumor-bearing segments and systemically injecting 1ml of ICG (2.5mg/ml). Our total successful rate of staining is 53%. No conversion to laparotomy, Clavien III-IV complication or 90-day mortality occurred. Valuable technical feedback, experience and lessons are learned from this initial practice. Real-time ICG fluorescence imaging adds much precision to laparoscopic anatomical hepatectomy. The success of segmental staining requires a high proficiency of IOUS and skillful interpretation of preoperative 3D simulation. Decision-making on the fashions of positive and negative staining have been initially recommended. Multi-centered practice and technical modification are necessary to standardize its application.

Assessment of Lymphovenous Anastomosis Patency: Technical Highlights.

Assessment of Lymphovenous Anastomosis Patency: Technical Highlights.

Sentinel lymph node biopsy for breast cancer using indocyanine green fluorescence visualization

We presented the preliminary results of sentinel lymph node biopsy (SLN) using the method of fluorescent visualization with the indocyanine green. The study included 40 breast cancer patients with the prevalence of the cTis-2N0M0 process. 1 ml of Indocyanine Green (ICG) aqueous solution was administered periareolarly and subcutaneously from the tumor side with total drug dose of 5 mg. In the following few minutes the ICG trail along the lymphatic vessels was observed by its fluorescence in the infrared spectral range using a special camera with image transmitted to a computer screen. After the trail reached the axillary region and broke off, skin and subcutaneous tissue incision in axillary area was made, and the superficial fascia was dissected. The first contrasted lymph nodes were extracted. The incidence of SLN was 92.5%. Metastases were detected in 20% of cases. On average, it took 17.6 minutes to identify and remove the SLN. In 7 patients the use of the fluorescent SLN detection method was combined with radioisotope (Technefite 99m Tc colloid) – in all cases the same SLN was identified. The use of the ICG lymphotropic dye with the subsequent detection of SLN by the fluorescence method makes it possible to diagnose the status of SLN with a high degree of accuracy and can be comparable in effectiveness with the isotopic method. The specificities of lymphatic drainage were found out with the use of fluorescence lymphography: inverse dependence of the lymphatic drainage rate on the body mass index and breast size, and absence of dependence on degree of ptosis of breast.

Technique, Outcomes With Navigational Bronchoscopy Using Indocyanine Green for Robotic Segmentectomy

The objectives of this study were to present outcomes of robotic segmentectomy and the investigators' preferred technique for nodule localization using indocyanine green both bronchoscopically and intravenously. This study was a retrospective review of a consecutive series of patients scheduled for robotic segmentectomy from a single surgeon's prospectively collected database. Between January 2010 and October 2018, there were 245 consecutive patients who underwent planned robotic segmentectomy by one surgeon. Of these 245 patients, 93 (38%) received indocyanine green by electromagnetic navigational bronchoscopy, and all 245 received intravenous indocyanine green. Median time for navigational bronchoscopy was 9 minutes. Navigational bronchoscopy with indocyanine green correctly identified the lesion in 80 cases (86%). The preferred technique was as follows: 0.5 mL of 25 mg of indocyanine green diluted in 10 mL of sterile water given bronchoscopically, followed by a 0.5-mL saline flush, staying at least 4 mm from the pleural surface. The remaining 9.5 mL of indocyanine green was administered intravenously after pulmonary artery ligation. An R0 resection was achieved in all 245 patients, a median of 17 lymph nodes were resected, and the average length of stay was 3.1 days (range, 1 to 21 days). Major morbidity occurred in 3 patients, and there were no 30- or 90-day mortalities. Robotic segmentectomy is safe, with excellent early clinical outcomes. In this series, electromagnetic navigational bronchoscopy and indocyanine green localization were efficient and effective at identifying the target lesion. Intravenous indocyanine green delineated the intersegmental plane.

Prospective clinical trial of robotic sentinel lymph node assessment with isosulfane blue (ISB) and indocyanine green (ICG) in endometrial cancer and the impact of ultrastaging (NCT01818739)

ObjectivesTo assess the performance sentinel lymph node (SLN) biopsy and effect of ultrastaging in clinically early stage endometrial cancer. MethodsPatients with endometrial cancer prospectively enrolled after informed consent was obtained. The cervix was injected superficially with 1 mL of ISB and 1 mL of ICG (diluted 1:25) at 3 and 9 o'clock each. SLN biopsy was followed by complete pelvic lymphadenectomy (aortic lymphadenectomy at the discretion of the surgeon). Lymph nodes (LNs) were analyzed by standard sectioning with H&E; ultrastaging of SLN was done retrospectively and blinded to treating physicians. Results204 patients received dye injections. In 184 (90.2%) patients at least one SLN was identified. Of all patients, 138 (68%) had bilateral mapping. In the patients with successful mapping of a hemipelvis, ICG detected SLNs in 83% and ISB in 64% of cases (p < 0.0001). Median BMI (kg/m2) for patients with successful mapping was 35.7 compared to 40.1 for those who did not map (p = 0.01). Twenty-three (11.3%) patients had positive LNs. Applying the SLN algorithm, positive nodes were detected in 21/23 (91.3%). The negative predictive value (NPV) was 98.9% (95% CI: 96.01% to 99.71%). Eleven patients had positive SLN with isolated tumor cells (ITCs) or micrometastases detected on ultrastaging. Including these patients, 34 (17%) had positive LNs, increasing the NPV to 99% and sensitivity to 94%. There were no recurrences in patients with ITCs only. ConclusionsSLN assessment in endometrial cancer is feasible and safe with high NPV (99%). ICG was more effective in detecting SLN compared to ISB. Although ultrastaging detected additional positive LNs, treatment based on standard sectioning appears reasonable but further research is needed.

Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery

PurposeThe aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery.MethodsBetween March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing.ResultsThe mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred.ConclusionEndoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

Two-step sentinel lymph node mapping strategy in endometrial cancer staging using fluorescent imaging: A novel sentinel lymph node tracer injection procedure

ObjectiveThe current sentinel lymph node (SLN) tracer injection procedure for endometrial cancer commonly uses cervical injection, which can detect SLNs of the uterine cervix but not the uterine body. This study describes an SLN tracer injection procedure, titled two-step SLN mapping, which can identify SLNs of the uterine body and cervix using fluorescent imaging with indocyanine green (ICG) and results of SLN biopsy. MethodsIn 50 consecutive patients with endometrial cancer, two-step SLN mapping was performed during laparoscopic surgical staging with the PINPOINT® real-time fluorescence imaging system. The first step was to identify SLNs of the uterine body. In total, 4–6 mL of ICG was injected into the bilateral uterine cornual areas, and lymphatic channels were traced, followed by identification and removal of paraaortic SLNs. The second step was to identify SLNs of the uterine cervix by injecting 4 mL of ICG into the cervix. After harvesting the mapped pelvic SLNs, complete pelvic and paraaortic lymphadenectomy was performed to validate the two-step SLN mapping strategy. ResultsOur two-step SLN mapping strategy produced excellent SLN detection rates: 100% (50/50) overall for SLNs; 98.0% (49/50) for pelvic SLNs; 94.0% (47/50) for bilateral SLNs; and 86.0% (43/50) for paraaortic SLNs. We detected microscopic metastasis in harvested SLNs of 4 patients (8.0%). The sensitivity, specificity, and negative predictive value of SLN detection were all 100%. There was no false negative case. ConclusionThe two-step SLN mapping strategy to identify lymph nodes from the uterine fundus and cervix was feasible. This strategy could be more accurate in identifying paraaortic lymph node metastasis than the cervical injection method.

Sentinel lymph node biopsy in cutaneous melanoma of the head and neck using the indocyanine green SPY Elite system

PurposeLymph node status is the single most important prognostic factor for patients with early-stage cutaneous melanoma. Sentinel lymph node biopsy (SLNB) has become the standard of care for intermediate depth melanomas. Modern SLNB implementation includes technetium-99 lymphoscintigraphy combined with local administration of a vital blue dye. However, sentinel lymph nodes may fail to localize in some cases and false-negative rates range from 0 to 34%. Here we demonstrate the feasibility of a new sentinel lymph node biopsy technique using indocyanine green (ICG) and the SPY Elite near-infrared imaging system. Materials and methodsCases of primary cutaneous melanoma of the head and neck without locoregional metastasis, underwent SLNB at a single quaternary care institution between May 2016 and June 2017. Intraoperatively, 0.25 mL of ICG was injected intradermal in 4 quadrants around the primary lesion. 10–15 minute circulation time was permitted. SPY Elite identified the sentinel lymph node within the nodal basin marked by lymphoscintigraphy. Target first echelon lymph nodes were confirmed with a gamma probe and ICG fluorescence. Results14 patients were included with T1a to T4b cutaneous melanomas. Success rates for sentinel lymph node identification using lymphoscintigraphy and the SPY Elite system were both 86%. Zero false negatives occurred. Median length of follow-up was 323 days. ConclusionsIn this pilot study, Indocyanine green near-infrared fluorescence demonstrates a safe, and facile method of sentinel lymph node biopsy for cutaneous melanoma of the head and neck compared with lymphoscintigraphy and vital blue dyes.