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Real-time Intraoperative Fluorescent Lymphography: A New Technique for Lymphatic Sparing Surgery.

G Ietto1, F Amico2, G Soldini1

  • 1General and Transplant Surgery Department, Insubria University, Varese, Italy.

Transplantation Proceedings
|December 10, 2016
PubMed
Summary

Indocyanine green (ICG) fluorescence lymphography safely maps lymphatic vessels during surgery. This technique helps surgeons avoid damaging deep lymphatic structures, reducing postoperative complications.

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Area of Science:

  • Surgical innovation
  • Medical imaging
  • Lymphatic system research

Background:

  • Surgical procedures can damage lymphatics, causing lymphorrhea, lymphoceles, and lymphedema.
  • Visualizing the lymphatic system during surgery is difficult.
  • Indocyanine green (ICG) fluorescence-guided lymphography offers a promising solution for intraoperative lymphatic mapping.

Purpose of the Study:

  • To develop a real-time, high-resolution intraoperative imaging technique.
  • To prevent or detect early damage to deep lymphatic vessels.

Main Methods:

  • Intraoperative ICG fluorescence-guided lymphography was performed during kidney transplantation.
  • ICG was injected subcutaneously in the groin's Scarpa's triangle.
  • A high-definition laparoscopic camera system was utilized for imaging.

Main Results:

  • Fluorescent lymphatic vessels were identified in the abdominal retroperitoneal space, adjacent to iliac vessels.
  • Surgical dissection successfully avoided iatrogenic damage to major lymphatic structures.
  • Post-procedure ICG injection confirmed lymphatic vessel integrity and absence of lymph spread.

Conclusions:

  • Intraoperative lymphatic mapping using ICG fluorescence is safe and feasible.
  • Real-time ICG fluorescence lymphography can prevent or identify deep lymphatic damage.
  • This technique may reduce lymphatic system-related postoperative complications.