Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
J Minim Invasive Gynecol. 2018 Mar-Apr;25(3):384-385. doi: 10.1016/j.jmig.2017.09.011. Epub 2017 Sep 20.
To present our minimally invasive laparoscopic approach for sentinel lymph node (SLN) mapping with indocyanine green (ICG) using 2 fluorescence systems.
A step-by-step video description of the technique showing the most frequent typical and atypical location of SLNs (educational video).
Lymph node staging in apparent confined endometrial cancer.
Women underwent SLN mapping in a minimally invasive setting.
Laparoscopic SLN mapping before comprehensive staging including simple hysterectomy, bilateral salpingo-oophorectomy, and pelvic and aortic bilateral lymphadenectomy in case of unilateral or no identification of SLNs. The PINPOINT 0 degree HD S1 SPY camera (PINPOINT Endoscopic Fluorescence Imaging System; NOVADAQ, Mississauga, ON, Canada) or the Full HD Image 1S with ICG camera (Karl Storz Endoscopy, Tuttlingen, Germany) were used for SLN detection [1,2]. The ICG powder was diluted to a final solution of 1.25 mg/mL of fluorescent dye. After the induction of general anesthesia, a total of 4 mL of the ICG solution was injected into the cervix at the 3 and 9 o'clock positions. Attention to the technical details is crucial to correctly identify SLNs that sometimes are located in atypical locations [3].
Both fluorescence systems are valid and applicable for SLN mapping in the case of apparent confined endometrial cancer. In our experience, the PINPOINT system seems to allow surgeons easier and faster nodal staging of the SLNs, particularly with the color-segmented fluorescence function activated, which can better discriminate between the lymphatic channels and the real SLNs [4,5].
介绍我们使用两种荧光系统进行吲哚菁绿（ICG）前哨淋巴结（SLN）示踪的微创腹腔镜方法。
展示 SLN 最常见典型和非典型位置的技术分步视频描述（教育视频）。
明显局限型子宫内膜癌的淋巴结分期。
在微创环境下接受 SLN 测绘的女性。
在全面分期前进行腹腔镜 SLN 测绘，包括单纯子宫切除术、双侧输卵管卵巢切除术，以及在单侧或未识别 SLN 的情况下行盆腔和主动脉双侧淋巴结切除术。使用 PINPOINT 0 度 HD S1 SPY 相机（PINPOINT 内窥镜荧光成像系统；NOVADAQ，安大略省密西沙加）或配备 ICG 相机的 Full HD Image 1S（Karl Storz 内窥镜，德国图特林根）进行 SLN 检测[1,2]。ICG 粉末稀释至终浓度为 1.25mg/mL 的荧光染料。全麻诱导后，将总共 4mL 的 ICG 溶液在宫颈 3 点和 9 点位置注射。注意技术细节对于正确识别有时位于非典型位置的 SLN 至关重要[3]。
在明显局限型子宫内膜癌的情况下，两种荧光系统均有效且适用于 SLN 测绘。根据我们的经验，PINPOINT 系统似乎允许外科医生更容易和更快地对 SLN 进行淋巴结分期，特别是激活彩色分段荧光功能，可以更好地区分淋巴管和真正的 SLN[4,5]。
