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Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy.

ABSTRACT: The aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy.Data were collected from all patients diagnosed with early-stage cervical cancer that underwent laser angiography with ICG during open or laparoscopic radical trachelectomy from June 2012 to December 2015. Regression analysis was use to determine the p values and R-squares on fluorescence, surgical time, hospital stay, age and BMI; a p-value<0.05 was considered statistically significant.A total of 20 patients met the inclusion criteria and were included in this study. Ten patients underwent uterine artery-sparing surgery, and ten patients underwent uterine artery non-sparing surgery. The most frequent stage for the entire cohort was IA2 (55%), and the most common histologic subtype was squamous cell carcinoma (49%). Lymph-vascular invasion was noted in 30% of the patients. There was no statistical significance difference in the mean ICG fundal fluorescence intensity between the uterine artery-sparing group 162.5 (range, 137-188) and the uterine artery non-sparing group 160.5 (range, 135-186), p=0.22. In both groups, 100% of the patients regained their menstrual function by postoperative week 8. A total of 4 (40%) pregnancies have occurred in the uterine artery-sparing group and 3 (30%) in the non-uterine artery-sparing group.Based on our real-time intraoperative angiography observations, there is no need to preserve the uterine artery during radical trachelectomy to maintain uterine viability.

SUBMITTER: Escobar PF

PROVIDER: S-EPMC5966828 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy.

Escobar Pedro F PF Ramirez Pedro T PT Garcia Ocasio Rafael E RE Pareja Rene R Zimberg Steve S Sprague Michael M Frumovitz Michael M

Gynecologic oncology 20160817 2

<h4>Objectives</h4>The aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy.<h4>Methods</h4>Data were collected from all patients diagnosed with early-stage cervical cancer that underwent laser angiography with ICG during open or laparoscopic radical trachelectomy from June 2012 to December 2015. Regression analysis was use to determine the p values and R-squares on fluorescence, sur ...[more]

PMID: 27544455

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Project description:ObjectivesIndocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences.MethodsActual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively.ResultsICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69-100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2-14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers.ConclusionsICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments.

Project description:Background and Objective Quantitative studies of indocyanine green (ICG) are needed to optimize its evaluative potential in anastomotic perfusion during colorectal surgery. However, some limitations still existed in current studies about qualitative evaluations such as small-scale studies, the inconsistent concentration of the drug, the method of injection, etc. Therefore, this review summarized the primary quantitative parameters, image, method, and so on, during ICG fluorescence angiography aiming to further provide a theoretical basis for the application of ICG in laparoscopic colorectal surgery. Methods The following keywords “indocyanine green or ICG”, “anastomotic perfusion”, and “colorectal surgery” were applied to search for literature published from 2002 to 2022 in the PubMed, Web of Science, and Medline databases. Then, the information about ICG fluorescence angiography in quantitative evaluation of anastomotic perfusion during colorectal surgery was summarized. Through integrating the experiences derived from the literature and our research center, the crucial quantitative parameters [such as T0, Tmax, Fmax, and S (Fmax/Tmax)], image characteristics, and standard operational process for ICG fluorescence angiography were summarized. Key Content and Findings Firstly, quantitative parameters, including T0, Tmax, Fmax, and S (Fmax/Tmax) during the ICG fluorescence angiography could predict anastomotic leakage, and thus should be recorded. Secondly, the image curve generated by the software might differ among patients, which included a filling period, reducing period, and platform period; some patients even presented a second fluorescence intensity peak. Finally, present studies presented great heterogeneity regarding the injection dose of ICG, observation distance from the laparoscope to the anastomotic site, software, and so on, during ICG fluorescence angiography in quantitatively evaluating the intestinal blood perfusion. Conclusions This review points out the challenges of ICG fluorescence angiography in quantitative evaluation of anastomotic perfusion and gives some advice. However, some difficulties and issues are non-neglectable during the clinical implications of the quantitative evaluation of ICG, such as standardizing the specific cut-off value about the quantitative parameters, injection dose of ICG, observation distance from the laparoscope to the anastomotic site, software, and so on, during ICG fluorescence angiography in quantitatively evaluating the intestinal blood perfusion to eliminate heterogeneity.

Dataset Information

Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy.

Publications

Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy.

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