Tsuge Itaru, Sowa Yoshihiro, Yamanaka Hiroki, Katsube Motoki, Sakamoto Michiharu, Morimoto Naoki
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2023 Jan 12;11(1):e4743. doi: 10.1097/GOX.0000000000004743. eCollection 2023 Jan.
The medical imaging projection system (MIPS) is a real-time surgical navigation device using indocyanine green (ICG) emission signals and active projection mapping. The difference between the object and the projected image is within 1 mm, and the time lag is within 0.1 seconds. We herein report the application of the MIPS to vascularized lymph-node transplantation (VLNT) surgery for lower extremity lymphedema to detect inguinal lymph nodes and perform color-coded navigation surgery for lymph-node resection. A left superficial inguinal lymph node was planned to be used as a donor for VLNT to the right lower leg in a 73-year-old woman with lower extremity lymphedema. Under general anesthesia, multiple intradermal injections of 0.1 ml of ICG were administered around the left inguinal donor site. The MIPS showed a clear linear projection image from a lateral injected point connecting to a lateral superficial inguinal lymph node. The left superficial circumflex iliac artery and vein were dissected for vascularized VLNT. Intraoperative real-time MIPS navigation continuously guided the transection plane colored by ICG fluorescence signals without shifting the visual focus from the surgical field. This is the first report of the intraoperative use of ICG projection mapping for VLNT donor-site surgery. The MIPS was able to visualize functional lymph nodes to facilitate minimally invasive donor-site surgery.
医学成像投影系统（MIPS）是一种利用吲哚菁绿（ICG）发射信号和主动投影映射的实时手术导航设备。物体与投影图像之间的差异在1毫米以内，时间滞后在0.1秒以内。我们在此报告MIPS在下肢淋巴水肿的血管化淋巴结移植（VLNT）手术中的应用，用于检测腹股沟淋巴结并进行淋巴结切除的彩色编码导航手术。一名73岁下肢淋巴水肿女性计划将左侧腹股沟浅淋巴结用作右下肢VLNT的供体。在全身麻醉下，在左侧腹股沟供体部位周围进行多次皮内注射0.1毫升ICG。MIPS显示从外侧注射点连接到外侧腹股沟浅淋巴结的清晰线性投影图像。解剖左侧旋髂浅动脉和静脉用于血管化VLNT。术中实时MIPS导航持续引导由ICG荧光信号染色的横断平面，而无需将视觉焦点从手术视野转移。这是ICG投影映射在VLNT供体部位手术中术中使用的首次报告。MIPS能够可视化功能性淋巴结，以促进微创供体部位手术。
