Fluoreszenzgesteuerte Lymphgefäßversiegelung bei der systematischen Lymphknotendissektion zur Vermeidung von Lymphfisteln und Lymphozelen

Zusammenfassung

Hintergrund Die wichtigsten Morbiditäten der systematischen inguinalen und axillären Lymphknotendissektion sind Lymphfisteln und Serome. Die intraoperative, fluoreszenzgesteuerte Versiegelung der Lymphgefäße könnte die Häufigkeit dieser postoperativen Komplikationen verringern.

Methoden Vor der Lymphadenektomie erfolgte die Intrakutaninjektion von Indocyanin-Farbstoff im Bereich der distalen Extremität. Die Lymphadenektomie wurde nach Standardprotokollen durchgeführt. Während des gesamten Eingriffs wurde Nahinfrarot-Bildgebung eingesetzt, und es wurde eine fluoreszenzgesteuerte Lymphgefäßversiegelung in Echtzeit durchgeführt (Videopräsentation).

Ergebnisse Die fluoreszenzgesteuerte Lymphgefäßversiegelung wurde bei 3 Patienten durchgeführt, die sich einer axillären systematischen Lymphknotendissektion unterzogen. Nach der Injektion des Fluoreszenzfarbstoffs traten keine unerwünschten Ereignisse auf. Alle Patienten konnten ohne Wundkomplikationen entlassen werden.

Schlussfolgerung Die fluoreszenzgesteuerte Lymphgefäßversiegelung könnte eine vielversprechende neue Technik zur Verhinderung von Lymphfisteln nach systematischer Lymphadenektomie sein.

Abstract

Introduction The primary morbidities of inguinal and axillary systematic nodal dissection are lymphatic fistulas and seromas. Intraoperative fluorescence imaging-guided sealing of lymph vessels may prevent these postoperative complications.

Methods Indocyanine dye was injected intracutaneously into the distal limb before the beginning of the lymphadenectomy. Systematic nodal dissection was performed according to standard protocols. Near-infrared imaging was applied throughout the procedure and real-time fluorescence-guided lymph vessel sealing was performed.

Results Fluorescence-guided lymph vessel sealing was implemented in three patients undergoing axillary systematic lymph node dissection. No adverse events occurred following fluorescence dye injection. All patients could be discharged free of wound complications.

Conclusion Fluorescence-guided lymph vessel sealing might be a promising new technique for preventing lymphatic fistulas and lymphocele after systematic lymphadenectomy.

Schlüsselwörter

Lymphadenektomie - Lymphknotendissektion - Fluoreszenzbildgebung - Indozyaningrün - Lymphozele

Keywords

lymphadenectomy - fluorescence imaging - lymph node dissection - lymphocele - indocyanine green

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