Applications in Gynecology
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Indocyanine green (ICG) is a fluorescent dye developed during World War II by Kodak. Initially meant to be employed in photography, it was granted FDA approval in 1959, after being tested in the United States at Mayo Clinic.
Ever since, its use via intravenous injection has found application in ophthalmology, but also in internal medicine and cardiology. In the last decades, ICG has been successfully employed in oncological surgery.
The main advantages, which led to a rapid acceptance of the compound, are the low rate of adverse effects and the rapid excretion, the presence of peak absorption around 800 nm, close to the isobestic point of hemoglobin. This allows the employment of ICG with near infrared light (NIR) for in vivo detection of tissue, with virtually no interference from background autofluorescence caused by water and blood, and excellent applicability in minimally invasive surgery. Indocyanine green has a half-life of around 3 min and is excreted almost exclusively through the bile.
KeywordsIndocyanine green Near infrared Sentinel lymph node mapping Endometrial cancer Cervical cancer Vulvar cancer
Laparoscopic ICG SLN mapping after cervical injection. ICG SLN mapping is performed in an endometrial cancer patient with a BMI of 35 kg/m2. After cervical injection, the retroperitoneal space in the right hemipelvis is opened and developed bluntly. Under NIR light, a fluorescent signal is identified. Through the closing of the optical diaphragm, the fluorescent signal becomes more dense and can therefore be seen better. Lateral to the uterus, a lymphatic channel running along the uterine vessels and leading to an SLN in the obturator fossa is identified. This represents the upper paracervical pathway. The fluorescent signal is identified and followed under NIR light, whereas the dissection is performed under direct light. Care must be payed not to disrupt the lymphatic vessels. This would allow the ICG lo leave the lymphatic vessels and would cause a diffuse stain of the fluorescent signal. (AVI 87049 kb)
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