Ietto G, Iovino D, Soldini G, Zani E, Parise C, Raveglia V, Ferri E, Latham L, Confalonieri D, Saredi G, Tozzi M, Carcano G
General, Emergency, and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
General, Emergency, and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
Transplant Proc. 2019 Mar;51(2):532-537. doi: 10.1016/j.transproceed.2018.12.008. Epub 2018 Dec 12.
Indocyanine green (ICG) fluorescence imaging system is a now a consolidated complementary technique for several surgical fields. The development of post-transplant lymphocele following lymph spread could affect kidney function; between therapeutic options, the literature reports a 12% overall conversion rate from laparoscopic to open surgery with a major risk of damaging the urinary tract.
The goal of the present study was to demonstrate that intraoperative ICG fluorescent imaging is a safe technique that can be used in laparoscopy establishing the exact location of the lymphocele and reducing intraoperative risks.
Fifty milligrams of ICG dissolved in 20 mL of saline solution was injected via percutaneous drainage placed into the lymphocele to decompress transplanted kidneys 2 weeks before a laparoscopic lymphocele marsupialization procedure.
During the first exploratory laparoscopy, in the flank and right iliac fossa, near the 2 renal grafts, fluorescence was identified in 3 raised areas that were the internal side of the lymphocele lobes. The lymphocele wall was dissected and 300 mL of serous fluid was aspirated after puncturing. A 5 cm breach was then made in the cyst wall using the Ultracision harmonic scalpel (Ethicon US). Afterwards, a pedicle of the omentum in the lymphocele core was interfered with and fixed by 2 stitches.
Laparoscopic surgery seems to be the preferred surgical option for the treatment of primary symptomatic lymphocele after kidney transplantation. Intraoperative ICG fluorescent imaging is a safe technique to establish the exact location of the lymphocele and reduces the risk of damaging urinary structures during surgery.
吲哚菁绿（ICG）荧光成像系统现已成为多个外科领域的成熟辅助技术。移植后淋巴管囊肿因淋巴扩散而发展可能影响肾功能；在治疗选择中，文献报道从腹腔镜手术转为开放手术的总体转化率为12%，且存在损伤尿路的重大风险。
本研究的目的是证明术中ICG荧光成像技术是一种安全的技术，可用于腹腔镜手术，确定淋巴管囊肿的确切位置并降低术中风险。
在腹腔镜下淋巴管囊肿开窗术2周前，通过经皮引流将溶解于20 mL盐溶液中的50毫克ICG注入淋巴管囊肿，以减轻移植肾的压力。
在首次探索性腹腔镜检查中，在双侧肾移植附近的侧腹和右髂窝，在3个隆起区域发现荧光，这些区域是淋巴管囊肿叶的内侧。解剖淋巴管囊肿壁，穿刺后吸出300 mL浆液性液体。然后使用超声刀（爱惜康美国公司）在囊肿壁上制造一个5厘米的切口。之后，对淋巴管囊肿核心内的大网膜蒂进行干预并用2针缝合固定。
腹腔镜手术似乎是肾移植后原发性有症状淋巴管囊肿治疗的首选手术方式。术中ICG荧光成像技术是确定淋巴管囊肿确切位置并降低手术中损伤泌尿结构风险的安全技术。
