How to Do a Laparoscopic Iliac Lymph Node Biopsy Under Indocyanine Green (ICG) Guidance

Isolated abdominal lymphadenopathy can be difficult to diagnose when lesions are inaccessible to percutaneous biopsy. We describe a laparoscopic common iliac lymph node biopsy performed using indocyanine green (ICG) fluorescence guidance. A 67-year-old woman with bilateral lower limb oedema was found to have an FDG-avid right common iliac lymph node causing ureteric compression and deep venous thrombosis. Following ultrasound-guided inguinal node ICG injection, near-infrared fluorescence imaging enabled localisation of the target node. Intravenous ICG further delineated adjacent iliac vessels, facilitating safe dissection and biopsy. Histology demonstrated reactive follicular hyperplasia. ICG fluorescence imaging may improve the safety and accuracy of laparoscopic intra-abdominal lymph node biopsy.