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Real-time Navigation for Vascularized Lymph-node Transplantation Using Projection Mapping with Indocyanine Green
Itaru Tsuge1, Yoshihiro Sowa1, Hiroki Yamanaka1
1Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Plastic and Reconstructive Surgery. Global Open
|February 13, 2023
Summary
This study introduces a novel medical imaging projection system (MIPS) for real-time surgical navigation. The MIPS effectively guides vascularized lymph-node transplantation (VLNT) surgery by visualizing lymph nodes with indocyanine green (ICG) fluorescence.
Area of Science:
- Surgical Navigation
- Medical Imaging
- Lymphatic Surgery
Background:
- Lymphedema significantly impacts quality of life, necessitating advanced surgical interventions.
- Vascularized lymph-node transplantation (VLNT) is a complex procedure requiring precise identification of lymph nodes.
- Current methods for lymph node visualization during surgery can be challenging.
Purpose of the Study:
- To evaluate the application of a medical imaging projection system (MIPS) for intraoperative navigation in vascularized lymph-node transplantation (VLNT) surgery.
- To assess the efficacy of indocyanine green (ICG) fluorescence and active projection mapping for detecting inguinal lymph nodes.
- To demonstrate the potential of MIPS for minimally invasive donor-site surgery in lower extremity lymphedema treatment.
Main Methods:
- Utilized a real-time medical imaging projection system (MIPS) integrating indocyanine green (ICG) emission signals and active projection mapping.
- Administered intradermal ICG injections around the donor lymph node site in a patient with lower extremity lymphedema.
- Performed color-coded navigation surgery guided by MIPS for lymph node resection and vascular pedicle dissection.
Main Results:
- The MIPS demonstrated high accuracy with a difference between object and projected image within 1 mm and a time lag under 0.1 seconds.
- Clear visualization of a superficial inguinal lymph node and its vascular supply was achieved using ICG fluorescence.
- Real-time MIPS navigation successfully guided the transection plane, facilitating minimally invasive donor-site surgery.
Conclusions:
- The medical imaging projection system (MIPS) is a viable tool for real-time surgical navigation in VLNT procedures.
- ICG fluorescence combined with MIPS projection mapping enables precise identification and resection of functional lymph nodes.
- This technology facilitates minimally invasive donor-site surgery, potentially improving outcomes for lymphedema patients.
