Esposito Ciro, Di Mento Claudia, Chiodi Annalisa, Cerulo Mariapina, Coppola Vincenzo, Del Conte Fulvia, Carraturo Francesca, Esposito Giovanni, Escolino Maria
Pediatric Surgery Unit, Department of Translational Medical Science, Federico II University, 80131 Naples, Italy.
CEINGE Biotechnology Center, 80131 Naples, Italy.
Children (Basel). 2023 Dec 30;11(1):54. doi: 10.3390/children11010054.
There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina Lens system.
All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina Lens for ICG fluorescence visualization.
A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head ( = 7), lymphangiomas of the head/neck ( = 2), thyroglossal duct cysts ( = 7), gynecomastia ( = 3), preauricular fistula ( = 2), second branchial cleft fistula ( = 1), fibrolipoma of the shoulder ( = 1) and myofibroma of the gluteal/perineal region ( = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia ( = 1), thyroglossal duct cyst ( = 1) and neck lymphangioma ( = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports.
Based on this initial experience, FGS using the Rubina Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.
关于在开放手术领域使用荧光引导手术（FGS）的文献很少。本研究旨在评估FGS在儿科人群开放手术中的实用性，并报告我们使用鲁比纳透镜系统的初步经验。
纳入2022年9月至2023年9月期间接受吲哚菁绿（ICG）荧光辅助开放手术的所有患者。每个手术过程均使用鲁比纳透镜进行ICG荧光可视化。
共纳入25例患者，其中14例男孩和11例女孩，手术时的中位年龄为5.8岁（范围0 - 15岁）。手术适应证包括头部皮样/表皮样囊肿（n = 7）、头颈部淋巴管瘤（n = 2）、甲状舌管囊肿（n = 7）、男性乳房发育症（n = 3）、耳前瘘管（n = 2）、第二鳃裂瘘管（n = 1）、肩部纤维脂肪瘤（n = 1）和臀/会阴区域肌纤维瘤（n = 2）。在所有手术中，均使用30号针头向瘤内注射2.5 mg/mL的ICG溶液。未发生对ICG的不良反应。中位手术时间为68.6分钟（范围35 - 189分钟）。所有病例均通过鲁比纳透镜实现了ICG近红外荧光（ICG-NIRF）可视化。未报告术中并发症。25例患者中有3例（12%）发生术后并发症，分别为男性乳房发育症（n = 1）、甲状舌管囊肿（n = 1）和颈部淋巴管瘤（n = 1），这些患者在手术部位出现积液，需要在门诊进行穿刺抽吸（Clavien-Dindo 2级）。病理报告证实肿块已完全切除。
基于这一初步经验，使用鲁比纳透镜的FGS在开放手术中非常有帮助，可增强解剖结构的可视化和切缘的识别，具有实时可靠性且并发症发生率低。它易于使用、节省时间、可行且临床安全。采用这项技术需要有微创外科手术（MIS）的既往经验。注射阶段的准确性对于避免ICG扩散到病变周围组织很重要。
