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New Navigation Surgery for Resection of Lymphatic Malformations Using Indocyanine Green Fluorescence Imaging

Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis)

Chiyoe Shirota, Akinari Hinoki, Masataka Takahashi, Yujiro Tanaka, Takahisa Tainaka, Wataru Sumida, Naruhiko Murase, Kazuo Oshima, Ryo Shirotsuki, Kosuke Chiba, Yuji Morimoto, Hiroo Uchida

(Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan)

Am J Case Rep 2017; 18:529-531

DOI: 10.12659/AJCR.903465

Available online:

Published: 2017-05-13

BACKGROUND: We used indocyanine green (ICG) fluorescence imaging to completely resect lymphatic malformations (LMs). This is the first report of navigation surgery utilizing ICG fluorescence imaging for resection of LMs.
CASE REPORT: A 15-year-old boy was diagnosed with LMs in the abdominal wall. The extent of the tumor was determined by an ultrasound, and ICG (Diagnogreen®, Daiichi-Sankyo Pharma, Tokyo, Japan) was injected subcutaneously and intradermally into the core and 2 marginal regions of the tumor (3 injections in total), respectively. During surgery, the extent of the tumor was confirmed with a photodynamic eye, and the tumor was completely resected. A fluorescent portion macroscopically estimated as normal was additionally resected and no residual fluorescence or tumor were confirmed in the remaining tissue. Abnormal lymphatic vessels were histopathologically observed in the additionally resected tissue, indicating the invasion of LMs. The surgery had a good outcome with no evidence of recurrence.
CONCLUSIONS: We performed near-infrared fluorescence-guided imaging surgery for the resection of LMs in the abdominal wall. This is a single case study; therefore, assessment of more cases is warranted for further validation. This procedure could provide significant benefit to patients requiring resection of LMs.

Keywords: Indocyanine Green, lymphangioma, optical imaging, Spectroscopy, Near-Infrared