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How to perform a laparoscopic pelvic sentinel lymph node dissection using near-infrared fluorescence with indocyanine green in gynecological cancers
  1. Elie Vésale1,
  2. Henri Azaïs1,2,
  3. Jérémie Belghiti1,
  4. Maryam Nikpayam1,2,
  5. Catherine Uzan1,2 and
  6. Geoffroy Canlorbe1,2
  1. 1 Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
  2. 2 Sorbonne University, Paris, France
  1. Correspondence to Henri Azaïs, Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, Paris 75013, France; henriazais{at}gmail.com

Abstract

The role of pelvic sentinel lymph node dissection (SLND) is increasing in oncological pelvic surgery, especially in the management of cervical and endometrial cancer.

SLND using indocyanine green (ICG) is safe and effective, and its sensitivity is higher than with other detection methods. The advantages of ICG are its low toxicity, its confinement within the vascular compartment, its rapid excretion, and the rarity of allergic reaction. These advantages confer to this fluorescent dye a superiority over blue, which can cause anaphylactic reactions. Using ICG does not require advance planning involving nuclear protection and delayed surgery, as are mandatory when using 99Tc detection. ICG allows the surgeon to visualize the lymph nodes through the peritoneum and thus avoid wide dissection.

According to European guidelines,1 the indications for SLND in cervical cancer are for patients with FIGO (International Federation of Gynecology and Obstetrics) IA1–IA2 disease, lymphovascular space involvement - positive status, without systematic pelvic lymphadenectomy – and patients with FIGO IB1–IIA1 disease, prior to systematic pelvic lymphadenectomy. Guidelines1 ,2 for endometrial cancer management state that SLND is indicated in cases of low-risk endometrial cancer (FIGO IA, grade 1–2), without systematic lymphadenectomy in cases of non-detection, with the technique being preferable to systematic lymphadenectomy in cases of intermediate-risk endometrial cancer (FIGO IB, grade 1–2, or FIGO IA, grade 3).2

Our objective is to review the technique of ICG injection and the real-time detection of pelvic SLNs using near-infrared imaging by means of a step-by-step explanation of the procedure using an instructional Video 1.

  • sentinel lymph node
  • fluorescence
  • indocyanine green
  • near-infrared imaging
  • gynecological cancer
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