Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Area of Science:

• Vascular surgery
• Medical imaging
• Lymphedema treatment

Background:

• Indocyanine green (ICG) lymphography aids lymphedema evaluation and lymphatic vessel detection.
• Intraoperative ICG imaging is often hindered by operating microscope light.
• Existing real-time ICG systems are typically integrated with specific microscopes.

Purpose of the Study:

• To evaluate a novel, microscope-independent ICG videolymphography system for lymphaticovenular anastomosis (LVA).
• To assess the system's efficacy in real-time ICG lymphography during LVA for upper extremity lymphedema.

Main Methods:

• A new high-resolution ICG videolymphography system, separate from the operating microscope, was utilized.
• The system separates near-infrared ICG fluorescence from visible microscope light.
• Ten patients with International Society of Lymphology stage 2 upper extremity lymphedema underwent LVA using this system.

Main Results:

• The system achieved an 86.7% intraoperative detection rate for lymphatic vessels (0.25-0.85 mm diameter).
• Lymph flow through lymphaticovenular anastomoses was confirmed in 76.7% of cases.
• Non-integrated ICG cameras failed to detect vessels or flow under standard microscope illumination.

Conclusions:

• Real-time ICG videolymphography, independent of the operating microscope, facilitates easier identification of lymphatic vessels during LVA.
• This technology enhances surgical accuracy and procedural flow in LVA for lymphedema.
• The system's ability to overlay ICG fluorescence with the surgical view improves precision in microsurgical procedures.