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, 7 (5), e2253
eCollection

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

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Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Yukio Seki et al. Plast Reconstr Surg Glob Open.

Abstract

Indocyanine green (ICG) lymphography is a useful imaging modality for evaluation of lymphedema and detection of lymphatic vessels. It also allows us to ensure patency of the anastomosed vessels intraoperatively. However, strong light from the operating microscope usually disturbs ICG fluorescence imaging. Only some built-in ICG camera systems with specific operating microscopes make real-time ICG lymphography possible in lymphaticovenular anastomosis (LVA). We applied a new high-resolution ICG videolymphography system, which is separated from the operating microscope. Because the system can divide near-infrared fluorescence light of ICG from visible light of the operating microscope, real-time ICG videolymphography-navigated LVA under operating microscope illumination is possible regardless types of operating microscopes. The study involved 10 patients with upper extremity lymphedema characterized by International Society of Lymphology stage 2 and treated by 3 lymphaticovenular anastomoses at the forearm (30 lymphaticovenular anastomoses incorporating 30 lymphatic vessels) under real-time ICG videolymphography. The rate of intraoperative detection of lymphatic vessels using real-time ICG videolymphography was 86.7% (0.25-0.85 mm in diameter), and that of lymph flow through the lymphaticovenular anastomoses was 76.7%. None of lymphatic vessels and no flow were detected under the microscope light by means of another non-built-in ICG lymphography camera. Real-time ICG videolymphography in LVA is beneficial, because the surgeon could find lymphatic vessels easily by checking dual images of original view and ICG fluorescent view and ensure accuracy of the LVA in a suture by a suture without any pauses of the surgical procedures.

Figures

Figure 1.
Figure 1.
The system of a new ICG videolymphography. A new ICG videolymphography system has a special dichroic prism, which can divide near-infrared fluorescence light of ICG from visible light, and each light is assessed by 2 different sensors.
Figure 2.
Figure 2.
Detection of the lymphatic vessel in stardust patterns using real-time ICG videolymphography imaging. ICG fluorescence images are clearly visualized by an ICG videolymphography under the microscope illumination of the xenon light. The system monitors the operation field real-timely by 3 different simultaneous images: original view with visible light, which include no ICG fluorescence images, ICG view with near-infrared fluorescence light images, and ICG plus original view, which combines original view and ICG view with enhancing ICG fluorescence as green color in the image.
Figure 3.
Figure 3.
Real-time ICG videolymphography imaging in lymphaticovenular anastomosis. The lymphatic vessel with a diameter of 0.50 mm under fat tissue is easily detected and anastomosed to a subcutaneous vein with a diameter of 0.40 mm. Lymph-to-venous flow of lymph is observed real-timely in performing the anastomosis.
Video Graphic 1.
Video Graphic 1.
See video, Supplemental Digital Content 1, which shows the real-time intraoperative ICG videolymphography in lymphaticovenular anastomosis. By real-time ICG fluorescence imaging, lymphatic vessels are easily detected and flow of lymph in the anastomosis is visible in a suture by a suture. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or at http://links.lww.com/PRSGO/B68.

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