Article Text
Abstract
Introduction Indocyanine green (ICG) has established its role in gynecological surgery as the standard dye for sentinel lymph node mapping (SLNM), while also enabling complex surgical procedures by facilitating anatomical identification like ureter demarcation. This educational video showcases different applications of ICG in a single surgical setting.
Description During a congress of the Argentine society of gynecological surgery, a live surgery was performed on a patient with gynecological cancer. The procedure begins with the injection of ICG into the ureters. Through cystoscopy, 4cm open-end catheter is inserted into each ureter, and 8ml of ICG is injected. After a 4-minute interval, the procedure is repeated on the opposite ureter. Upon laparoscopic visualization in the abdominal cavity, both ureters are identified using infrared light. The next step involves the cervical injection of ICG: 1.25mg of ICG is injected superficially at time 3 and 9 using a 21G spinal needle. Retroperitoneal dissection of both pelvic sides is then performed, allowing the identification of vascular structures and the visualization of the green ureters. An external iliac sentinel lymph node (SLN) is detected in the left pelvis, while no SLN is found in the right pelvis. further dissection reveals a primary iliac SLN. Both SLNs are extracted and placed in a pouch, identified extracorporeally, and sent for biopsy. Different key places to identify the ureter are shown on the video
Conclusion/Implications ICG has become a standard tool in gynecologic oncology for SLNM, also proving beneficial in more intricate surgeries such as those involving deep endometriosis.