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Tan GHM, Feng J, Kok YO, Tan PWW, Wong AWJ. Nylon Suture Loop for Tagging Lymphatic Channels during Lymphaticovenular Anastomosis. Indian J Plast Surg 2024; 57:136-139. [PMID: 38774728 PMCID: PMC11105814 DOI: 10.1055/s-0044-1779477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Background Lymphaticovenular anastomosis (LVA) requires special supermicrosurgery techniques designed for vessels less than 0.8 mm in size. While preparing the field for LVA, it is often difficult to handle the lymphatic vessel directly without injuring it or fracturing it entirely. Method We propose a novel technique, which is used in LVA for tagging of lymphatic vessels, with the use of a nylon 6-0 suture and micro-ligaclip. Results We have successfully performed 78 LVAs in 26 cases with this method. The average lymphatic vessel size was 0.3 mm (0.15-0.8 mm). Conclusion This novel technique to implement the use of a nylon suture with a micro-ligaclip to use as a vessel loop for lymphatics has not been previously described in the literature. It is a useful technique that we find beneficial to lymphatic identification through tagging of the lymphatic channels, contributing to greater success in each anastomosis.
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Affiliation(s)
- Grace Hui-Min Tan
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Jiajun Feng
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Yee Onn Kok
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Pearlie Woon Woon Tan
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Allen Wei-Jiat Wong
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
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2
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Aron A, Zavaleta C. Current and Developing Lymphatic Imaging Approaches for Elucidation of Functional Mechanisms and Disease Progression. Mol Imaging Biol 2024; 26:1-16. [PMID: 37195396 PMCID: PMC10827820 DOI: 10.1007/s11307-023-01827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
Study of the lymphatic system, compared to that of the other body systems, has been historically neglected. While scientists and clinicians have, in recent decades, gained a better appreciation of the functionality of the lymphatics as well as their role in associated diseases (and consequently investigated these topics further in their experimental work), there is still much left to be understood of the lymphatic system. In this review article, we discuss the role lymphatic imaging techniques have played in this recent series of advancements and how new imaging techniques can help bolster this wave of discovery. We specifically highlight the use of lymphatic imaging techniques in understanding the fundamental anatomy and physiology of the lymphatic system; investigating the development of lymphatic vasculature (using techniques such as intravital microscopy); diagnosing, staging, and treating lymphedema and cancer; and its role in other disease states.
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Affiliation(s)
- Arjun Aron
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
- Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA, 90089, USA
| | - Cristina Zavaleta
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA.
- Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA, 90089, USA.
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3
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Ju M, Yoon K, Lee S, Kim KG. Single Quasi-Symmetrical LED with High Intensity and Wide Beam Width Using Diamond-Shaped Mirror Refraction Method for Surgical Fluorescence Microscope Applications. Diagnostics (Basel) 2023; 13:2763. [PMID: 37685301 PMCID: PMC10486995 DOI: 10.3390/diagnostics13172763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
To remove tumors with the same blood vessel color, observation is performed using a surgical microscope through fluorescent staining. Therefore, surgical microscopes use light emitting diode (LED) emission and excitation wavelengths to induce fluorescence emission wavelengths. LEDs used in hand-held type microscopes have a beam irradiation range of 10° and a weak power of less than 0.5 mW. Therefore, fluorescence emission is difficult. This study proposes to increase the beam width and power of LED by utilizing the quasi-symmetrical beam irradiation method. Commercial LED irradiates a beam 1/r2 distance away from the target (working distance). To obtain the fluorescence emission probability, set up four mirrors. The distance between the mirrors and the LED is 5.9 cm, and the distance between the mirrors and the target is 2.95 cm. The commercial LED reached power on target of 8.0 pW within the wavelength band of 405 nm. The power reaching the target is 0.60 mW in the wavelength band of 405 nm for the LED with the beam mirror attachment method using the quasi-symmetrical beam irradiation method. This result is expected to be sufficient for fluorescence emission. The light power of the mirror was increased by approximately four times.
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Affiliation(s)
- Minki Ju
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Republic of Korea; (M.J.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science & Medicine, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| | - Kicheol Yoon
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Republic of Korea; (M.J.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science & Medicine, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| | - Sangyun Lee
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Republic of Korea; (M.J.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science & Medicine, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| | - Kwang Gi Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Republic of Korea; (M.J.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science & Medicine, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, 38-13, 3 Dokjom-ro, Namdong-gu, Incheon 21565, Republic of Korea
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4
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Seki Y, Kajikawa A, Asai R, Tomochika M, Nemoto H, Terashima T, Kurogi N. The Dynamic Lymphaticovenular Anastomosis for Breast Cancer-related Lymphedema without Compression: Salvaging Lymphedema Patients Who Lost Conservative Treatment Opportunity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5175. [PMID: 37577241 PMCID: PMC10412430 DOI: 10.1097/gox.0000000000005175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/22/2023] [Indexed: 08/15/2023]
Abstract
In conservative treatment for breast cancer-related lymphedema (BCRL), compression therapy has a crucial role. However, some BCRL patients are unable to use compression, and then their lymphedema continues to worsen as they miss treatment opportunity. Although lymphaticovenular anastomosis (LVA) is an effective and minimally invasive surgical treatment for BCRL, compression therapy is still important to enhance lymphatic fluid flow in LVA. The authors previously reported the dynamic LVA method for BCRL, in which patient's natural hand movements theoretically propel lymph to the anastomosed vein. This study is conducted to clarify whether dynamic LVA can salvage BCRL patients without pre- and postoperative compression therapy. Methods The study involved 17 BCRL patients, 18 limbs. All patients had International Society of Lymphology stage-2 lymphedema, but they had no compression: six patients had difficulty by other diseases to undergo compression, and other 11 patients refused any compression usage because of the burden of the treatment itself. Three dynamic LVAs were performed in each patient. Results Patients' mean age was 60.4 ± 10.1, and mean body mass index was 24.0 ± 3.3. The mean follow-up period was 25.5 ± 9.2 months. The volume of the lymphedematous limb, according to the upper extremity lymphedema (UEL) index, was reduced in all 18 limbs postoperatively (postoperative UEL index 101.8 ± 9.4 versus preoperative UEL index 116.0 ± 20.1; P < 0.01). Twelve of the 18 limbs were cured without edema. Conclusion Even without compression therapy, International Society of Lymphology stage-2 BCRL patients can be treated by the dynamic LVA method.
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Affiliation(s)
- Yukio Seki
- From the Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan
| | - Akiyoshi Kajikawa
- From the Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Rintaro Asai
- From the Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan
| | - Mayo Tomochika
- From the Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan
| | - Hitoshi Nemoto
- Department of Plastic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takahiro Terashima
- Department of General Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan
| | - Norimitsu Kurogi
- Department of General Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan
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5
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[Complications and their management following axillary, inguinal and iliac lymph node dissection]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:130-137. [PMID: 36255475 DOI: 10.1007/s00104-022-01736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
Irrespective of numerous technical developments, lymphadenectomy remains a necessary component of surgical tumor therapy. Depending on the extent and anatomical localization, complications associated with the lymph vessels such as lymphoceles, lymphatic fistulas or secondary lymphedema can occur with varying frequency, despite a meticulous dissection technique. Chronic lymph fistulas or lymphoceles often require interventional or surgical procedures. Pedicled or free microsurgical flaps are often required in the case of coexisting wound healing disorders or skin soft tissue defects, especially in an irradiated area. For secondary lymphedema a number of conservative and surgical treatment methods have been established. Adequate guideline-based conservative treatment is the method of first choice. If this does not lead to the desired result, microsurgical reconstructive, deviating or resecting procedures are available.
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A Novel Real-time Navigation System for Lymphaticovenular Anastomosis Using Projection Mapping with Indocyanine Green Fluorescence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3758. [PMID: 34414061 PMCID: PMC8367030 DOI: 10.1097/gox.0000000000003758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
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7
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Yamamoto M, Ninomiya H, Handa T, Kidawawa K, Inoue K, Sato T, Hanazaki K, Orihashi K. The impact of the quantitative assessment procedure for coronary artery bypass graft evaluations using high-resolution near-infrared fluorescence angiography. Surg Today 2021; 52:485-493. [PMID: 34415437 DOI: 10.1007/s00595-021-02357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Near-infrared angiography (NIR) is used for on-site graft assessment during coronary artery bypass grafting. This study evaluated the results of a quantitative NIR assessment using a new high-resolution NIR device (h-NIR) for graft assessment. METHODS Forty-three patients were enrolled in our study. Internal thoracic artery (ITA) grafts anastomosed to the left anterior descending artery and examined intraoperatively using h-NIR were included. The ITA grafts were divided into 2 groups for a comparative analysis: patent grafts (P group; n = 37) and failed grafts (F group; n = 6). The graft flow was evaluated by a "quantitative NIR assessment", and the fluorescence luminance intensity (FLI) was measured. Direct observation of the graft and anastomosis with h-NIR was also performed. RESULTS The FLI was higher in the P group than in the F group. The receiver operating characteristic analysis revealed the following cut-off values for FLIs depending on imaging duration: 21.1% at 1 s, 35.5% at 2 s, 58.4% at 3 s, and 83.3% at 4 s. The sensitivity and specificity for detecting graft failure were 83.3% and 69.8-80.6%, respectively. Furthermore, h-NIR was also able to visualize arterial dissection in ITA grafts. CONCLUSIONS A quantitative NIR assessment with an h-NIR device can improve the detectability of anastomotic stenosis, and h-NIR successfully detected arterial dissection of grafts.
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Affiliation(s)
- Masaki Yamamoto
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan. .,Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.
| | - Hitoshi Ninomiya
- Department of Civil and Environmental Engineering, Toyo University, Kawagoe City, Saitama, 350-8585, Japan
| | - Takemi Handa
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Koichi Kidawawa
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Urology, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Cardiovascular Control, Kochi Medical School,Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
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8
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Karakawa R, Yano T, Yoshimatsu H. Use of the wearable smart glasses for intraoperative indocyanine green (ICG) lymphography of a lymphatic surgery. Microsurgery 2021; 41:697-698. [PMID: 34329503 DOI: 10.1002/micr.30793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/26/2021] [Accepted: 07/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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9
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Thammineedi SR, Saksena AR, Nusrath S, Iyer RR, Shukla S, Patnaik SC, Reddy RP, Boleneni N, Sharma RM, Smith L, Are C. Fluorescence-guided cancer surgery-A new paradigm. J Surg Oncol 2021; 123:1679-1698. [PMID: 33765329 DOI: 10.1002/jso.26469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Fluorescence-guided surgery is an emerging and promising operative adjunct to assist the surgeon in various aspects of oncosurgery, ranging from assessing perfusion, identification, and characterization of tumors and peritoneal metastases, mapping of lymph nodes/leaks, and assistance for fluorescence-guided surgery (FGS). This study aims to provide an overview of principles, currently available dyes, platforms, and surgical applications and summarizes the available literature on the utility of FGS with a focus on abdomino-thoracic malignancies.
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Affiliation(s)
- Subramanyeshwar Rao Thammineedi
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Ajesh Raj Saksena
- Division of Colorectal Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Syed Nusrath
- Division of Upper GI Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Rajagopalan Iyer
- Division of Gynecologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Srijan Shukla
- Division of Thoracic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Pratap Reddy
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Naren Boleneni
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rakesh M Sharma
- Division of Urologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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10
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Chao AH, Schulz SA, Povoski SP. The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery. Expert Rev Med Devices 2021; 18:367-374. [PMID: 33686906 DOI: 10.1080/17434440.2021.1900725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Lymphedema has traditionally been managed through noninvasive means with complete decongestive therapy. However, complete decongestive therapy is an intensive program that requires lifelong adherence by patients with lymphedema. More recently, reconstructive surgical procedures have shown promise in improving lymphedema by physiologically restoring lymphatic function. One of these types of procedures, lymphaticovenular anastomosis, relies on technological advances in imaging, particularly indocyanine green lymphangiography. AREAS COVERED This article reviews indocyanine green and near-infrared fluorescence imaging. In addition, this article discusses the application of this imaging to the preoperative, intraoperative, and postoperative assessment of the lymphatic system in the setting of lymphaticovenular anastomosis surgery. EXPERT OPINION Indocyanine green lymphangiography offers significant advantages over other types of imaging of the lymphatic system. In the future, it is hopeful that additional options for these imaging devices will become available which may increase their accessibility by centers interested in performing reconstructive lymphatic surgery, including in relation to cost. Finally, more studies with higher levels of evidence are needed to better define the long-term outcomes associated with lymphatic surgery including LVA. In this regard, practitioners should fully harness the information conferred by ICG lymphangiography as both a clinical and research tool.
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Affiliation(s)
- Albert H Chao
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Steven A Schulz
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, Ohio State University, Columbus, OH, USA
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Aoyama M, Takizawa H, Yamamoto K, Inui T, Miyamoto N, Sakamoto S, Kobayashi T, Uehara H, Tangoku A. Effects of excitation light intensity on parathyroid autofluorescence with a novel near-infrared fluorescence imaging system: two surgical case reports. Gland Surg 2020; 9:1584-1589. [PMID: 33224835 DOI: 10.21037/gs-20-386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The intraoperative identification and preservation of the parathyroid glands are vital techniques, which are largely dependent on a surgeon's experience. Therefore, a simple and reproducible technique to identify the parathyroid glands during surgery is needed. Parathyroid tissue shows near-infrared (NIR) autofluorescence, which enables the intraoperative identification of the parathyroid gland. We herein present two cases that underwent surgery on the parathyroid glands, which were observed using the NIR fluorescence imaging system LIGHTVISION® (Shimazu, Kyoto, Japan). In a case of papillary thyroid carcinoma, the system was adopted to preserve normal parathyroid glands during left hemithyroidectomy. The left lower parathyroid gland was identified using the imaging system under white light; however, its autofluorescence was visualized more clearly with the excitation light of NIR. In a case of primary hyperparathyroidism due to MEN1, the system was adopted to identify and remove all of the parathyroid glands during total parathyroidectomy. The autofluorescence of diseased glands was weaker than that of normal glands, even with the excitation light of NIR. When the parathyroid glands were irradiated with a red laser pointer, the intensity of autofluorescence significantly increased. However, the largest gland, which was pathologically proven to contain strongly proliferating chief cells, did not show autofluorescence. These results suggest that normal or less diseased parathyroid glands, which are generally small and difficult to identify during surgery, showed relatively strong autofluorescence. A stronger excitation light increases the autofluorescence of parathyroid glands, which enhances sensitivity for detecting parathyroid glands during surgery. In conclusion, LIGHTVISION® is a useful device to identify parathyroid glands and an additional excitation light of a red laser pointer increases the detection sensitivity.
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Affiliation(s)
- Mariko Aoyama
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Kiyoshige Yamamoto
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Tomohiro Inui
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Naoki Miyamoto
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Shinichi Sakamoto
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
| | - Tomoko Kobayashi
- Department of Pathology, Tokushima University Hospital, Kuramoto-cho, Tokushima, Japan
| | - Hisanori Uehara
- Department of Pathology, Tokushima University Hospital, Kuramoto-cho, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan
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Drobot A, Ganam S, Karra N, Bickel A, Abu Shakra I, Kakiashvili E. Resection of an axillary macrocystic lymphatic malformation in a 14-year-old girl using intraoperative indocyanine green lymphography. J Vasc Surg Venous Lymphat Disord 2020; 9:504-507. [PMID: 32325148 DOI: 10.1016/j.jvsv.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
Lymphangioma is a malformation of the lymphatic system for which surgical excision is a possible treatment. However, complete excision may be hindered by the lesion's size, anatomic location, unclear borders, and invasion into adjacent tissues. We describe a 14-year-old girl who presented with a rapidly progressing axillary swelling. Magnetic resonance imaging and ultrasound revealed a lymphatic macrocystic multilocular lesion. After preoperative and intraoperative indocyanine green lymphography, a complete surgical excision was achieved without damage to collateral lymphatic channels or surrounding tissues. Intraoperative indocyanine green lymphography may be useful in achieving efficient and safe resection of lymphangioma without damaging unconnected lymphatics.
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Affiliation(s)
- Assi Drobot
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Samer Ganam
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Nour Karra
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Amitai Bickel
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | | | - Eli Kakiashvili
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel.
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Lee SH, Hong JP. MR Lymphangiography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:70-80. [PMID: 36238120 PMCID: PMC9432101 DOI: 10.3348/jksr.2020.81.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/07/2020] [Accepted: 01/14/2020] [Indexed: 12/03/2022]
Abstract
림프부종의 수술적 치료는 최근 늘어나고 있으며 그에 따른 림프관 평가를 위해 자기공명영상 획득이 증가하고 있다. 전통적인 T2 강조영상에서부터 삼차원 영상에 이르기까지 많은 발전이 이루어지고 있는 분야이다. 삼차원 영상으로는 spoiled gradient echo 영상이 있고 그 변형기법들이 시행되고 있으며 영상에 필수적인 지방억제기법은 최근 mDixon 기법이 각광받고 있다.
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Affiliation(s)
- Sang Hoon Lee
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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14
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O'Melia MJ, Lund AW, Thomas SN. The Biophysics of Lymphatic Transport: Engineering Tools and Immunological Consequences. iScience 2019; 22:28-43. [PMID: 31739172 PMCID: PMC6864335 DOI: 10.1016/j.isci.2019.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/25/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022] Open
Abstract
Lymphatic vessels mediate fluid flows that affect antigen distribution and delivery, lymph node stromal remodeling, and cell-cell interactions, to thus regulate immune activation. Here we review the functional role of lymphatic transport and lymph node biomechanics in immunity. We present experimental tools that enable quantitative analysis of lymphatic transport and lymph node dynamics in vitro and in vivo. Finally, we discuss the current understanding for how changes in lymphatic transport and lymph node biomechanics contribute to pathogenesis of conditions including cancer, aging, neurodegeneration, and infection.
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Affiliation(s)
- Meghan J O'Melia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Amanda W Lund
- Departments of Cell Developmental Cancer Biology, Molecular Microbiology & Immunology, and Dermatology, Knight Cancer Institute, Oregon Health & Science University, 2720 SW Moody Avenue, KR-CDCB, Portland, OR 97239, USA.
| | - Susan N Thomas
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA 30332, USA; Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Dr NW, Georgia Institute of Technology, Atlanta, GA 30332, USA; George W. Woodruff School of Mechanical Engineering, 801 Ferst Dr NW, Georgia Institute of Technology, Atlanta, GA 30332, USA; Winship Cancer Institute, 1365 Clifton Rd, Emory University, Atlanta, GA 30322, USA.
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15
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Blei F. Update October 2019. Lymphat Res Biol 2019. [DOI: 10.1089/lrb.2019.29072.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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