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1207 The use of indocyanine green for video-endoscopic bilateral sentinel lymph node biopsy in vulvar cancer: surgical technique
  1. Filippo Maria Capomacchia1,
  2. Nicolò Bizzarri2,
  3. Giacomo Guidi3,
  4. Anna Fagotti4,
  5. Giorgia Garganese5,
  6. Giovanni Scambia6 and
  7. Angelica Naldini5
  1. 1Catholic University of the Sacred Heart, Rome, Italy
  2. 2UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  3. 3Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4Dipartimento Scienze della Salute della Donna, del Bambino e di Sanita` Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
  5. 5Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  6. 6Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy


Introduction/Background The standard surgical treatment of vulvar carcinoma < 4 cm in size without clinical or radiological suspicion of lymph node metastases consists of resection of the vulvar tumor with negative margins with mono- or bilateral sentinel lymph node (SLN) biopsy performed by inguinal incision. Video-endoscopic inguinal sentinel lymph node biopsy with indocyanine green in vulvar cancer has been previously described. However, indocyanine green (ICG) induces fleeting mapping of lymphatic channels and sentinel lymph nodes. The surgical technique for patients with vulvar cancer with central lesions requiring bilateral SLN with ICG has not been reported yet.

Methodology In this video, we present the case of an 84 years-old patient with 3 cm central anterior vulvar squamous cell carcinoma. Radiotracer 99-Technetium) was injected in the vulva the day before surgery. Bilateral inguinal SLN biopsy was performed with video-endoscopic approach using ICG and confirmed with gamma probe detection.

Results The vulvar-vaginal examination under general anesthesia reported a central anterior vulvar lesion of 3 cm. The procedure began with the preparation of bilateral video-endoscopic access. First step was placement of a 15mm main trocar distal to the apex of the femoral triangle and two accessory trocars on the anterior surface of both thighs. ICG (1.25 mg/ml) was injected around the tumor. Blunt dissection up to the inguinal ligament was performed bilaterally. The lymphatic tissue was identified from the fascia lata with a combination of blunt and sharp dissection up to the fossa ovalis. SLNs were bilaterally identified with near-infrared detection and then resected .

Conclusion The use of ICG to identify bilateral SLNs in case of central tumors with video-endoscopic approach was feasible. The evanescent mapping of ICG did not affect the bilateral SLN detection. In order to minimize the fleeting uptake of indocyanine green, we suggest to perform the injection after bilateral preparation of video-endoscopic access.

Disclosures None.

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