Hirche Christoph, Engel Holger, Kolios Leila, Cognie Juliette, Hünerbein Michael, Lehnhardt Marcus, Kremer Thomas
1Trauma Centre Ludwigshafen, Ludwigshafen, Germany.
Surg Innov. 2013 Oct;20(5):516-23. doi: 10.1177/1553350612468962. Epub 2012 Dec 27.
BACKGROUND: Visualization of the lymphatic system is challenging. Lymphatic imaging is a crucial diagnostic tool for benign and malignant lymphatic pathologies. Fluorescence-guided imaging allows selective lymphatic mapping and sentinel lymph node (SLN) identification. There are a few fluorescence systems, but some drawbacks remain due to technical and ergonomic aspects. The aim of this study was to evaluate the feasibility of the new Fluobeam 800 imaging system. METHODS: After approval by the ethics committee, the system was evaluated for lymphography and SLN biopsy in an animal model. Five pigs each with 4 lymph node (LN) stations (n = 20 LN stations) were subjected to lymphatic imaging using indocyanine green (ICG). Additionally, the use of ICG was compared with ICG adsorbed to human serum albumin (ICG-HSA). Lymphatic vessels and SLN identification rates were measured. RESULTS: After injection, a clear fluorescence signal of the lymphatic vessels was visualized leading to the LN station. Overall, ICG fluorescence imaging identified a mean of 2.0 lymphatic vessels and 1.1 (range = 1-2) SLN in 20 of 20 LN stations. Reverse lymphography was feasible. A clinical difference in resolution was not detected between use of ICG-HSA and ICG. CONCLUSION: This is the first study analyzing the feasibility of the Fluobeam 800 imaging system allowing transcutaneous real-time imaging. It enables detection of the SLN by fluorescence retention with increased detection depth and resolution. After fixation to the ceiling, the ergonomics advanced for simultaneous field navigation and dissection. The new system can be applied for lymphatic imaging for lympatico-reconstructive surgery and SLN biopsy.
背景:淋巴系统的可视化具有挑战性。淋巴成像对于良性和恶性淋巴疾病是一种关键的诊断工具。荧光引导成像可实现选择性淋巴绘图和前哨淋巴结(SLN)识别。现有的荧光系统有几种,但由于技术和人体工程学方面的原因,仍存在一些缺点。本研究的目的是评估新型Fluobeam 800成像系统的可行性。 方法:经伦理委员会批准后,在动物模型中对该系统进行淋巴造影和SLN活检评估。五只猪,每只猪有4个淋巴结(LN)部位(共20个LN部位),使用吲哚菁绿(ICG)进行淋巴成像。此外,将ICG的使用与吸附于人血清白蛋白的ICG(ICG-HSA)进行了比较。测量淋巴管和SLN的识别率。 结果:注射后,可看到通向LN部位的淋巴管有清晰的荧光信号。总体而言,在20个LN部位中的20个部位,ICG荧光成像平均识别出2.0条淋巴管和1.1个(范围为1 - 2个)SLN。逆向淋巴造影是可行的。未检测到ICG-HSA和ICG在分辨率上的临床差异。 结论:这是第一项分析Fluobeam 800成像系统经皮实时成像可行性的研究。它能够通过荧光保留检测SLN,且检测深度和分辨率有所提高。固定在天花板上后,人体工程学得到改进,便于同时进行视野导航和解剖。新系统可应用于淋巴重建手术的淋巴成像和SLN活检。
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