Objectives To describe step-by-step the technique of ICG injection and the real-time detection of pelvic Sentinel Lymph Nodes using near-infrared imaging.
Methods This is a surgical teaching video demonstrating SLN mapping in uterine cancer using assisted fluorescence imaging. One milliter of Indocyanine green (2,5 mg/ml) is injected in 2 points into the cervix (deeply in the stroma and/or superficially in the submucosa) at 3 and 9 o’clock with a 22G needleunder anesthesia at the beginning of the operation or after set-up of the surgical access.
Results We suggest opening first the entire retroperitoneal space along the external iliac vessels and to identify the ureter and the obliterated umbilical artery. This approach allows to observe the early drainage from the cervix through the parametrium by following the dye progression in the channels before any node is taken to ensure that the true draining SLN is identified and not missed. Although the false negative rate may be limited by increasing the number of SLNs sampled, not all detected nodes should be taken but only the first draining node in the channel pathway has to be removed and labeled as SLN. This strategy permits to perform a real SLN-mapping and avoids considering as SLNs non-SLNs which correspond in fact to distal migration of tracer beyond the true SLN.However, in case of truly separate channels which may correspond to distinct pathway, more SLNs should be sample.
Conclusions NIR fluorescence ICG demonstrated its ability for real-time intraoperative vizualisation and detection of SLN in early-stage cervical cancer.
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