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The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

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Flow Pattern Classification in Lymphatic Malformations by Indocyanine Green Lymphography.

Motoi Kato¹, Shoji Watanabe¹, Takuya Iida¹

¹From the Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center; the Lymph Clinic, Children's Medical Center; and the Department of Plastic and Reconstructive Surgery, University of Tokyo.

Plastic and Reconstructive Surgery

|March 1, 2019

Summary

Indocyanine green lymphography reveals lymphatic flow patterns in malformations. A new classification system based on these patterns may improve surgical treatments for this congenital lymphatic disorder.

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Area of Science:

Vascular Surgery
Pediatric Surgery
Medical Imaging

Background:

Lymphatic malformation is a congenital disorder affecting lymphatic vessels.
Current understanding of lymphatic flow in these malformations is limited.
Indocyanine green lymphography offers a method for detailed lymph flow assessment.

Purpose of the Study:

To visualize in vivo lymph flow around lymphatic malformations using indocyanine green lymphography.
To establish a novel classification system for lymphatic malformations based on observed lymph flow patterns.

Main Methods:

Indocyanine green lymphography was performed on 20 pediatric patients with lymphatic malformations.
Patients ranged from 11 months to 10 years old.
The study focused on intractable microcystic or mixed-type lymphatic malformations.

Main Results:

Successful lymphography was achieved in all patients.
Four distinct lymph flow patterns were identified and classified.
Patterns included strong inflow, multiple small inflows, superficial flow, and peripheral flow around the lesion.

Conclusions:

The study successfully visualized lymphatic flow in malformations using indocyanine green lymphography.
A new classification system for lymphatic malformations based on flow patterns was proposed.
This classification may enhance the development of surgical interventions.