Ignacio Zapardiel1, Julio Alvarez2, Manel Barahona3, Pere Barri4, Ana Boldo5, Pera Bresco6, Isabel Gasca7, Ibon Jaunarena8, Ali Kucukmetin9, Gloria Mancebo10, Borja Otero11, Fernando Roldan12, Ramón Rovira13, Enma Suarez14, Alvaro Tejerizo15, Anna Torrent16, Mikel Gorostidi17. 1. Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain. 2. Obstetrics and Gynecology Department, Infanta Sofia University Hospital, Madrid, Spain. 3. Gynecology Department, Puerto Real University Hospital, Cádiz, Spain. 4. Gynecologic Surgery Unit, Hospital Quiron Dexeus, Barcelona, Spain. 5. Obstetrics and Gynecology Department, Hospital de la Plana, Castellón, Spain. 6. Gynecology Department, Hospital de Igualada, Barcelona, Spain. 7. Gynecology Department, Hospital de Valme, Seville, Spain. 8. Gynecologic Unit, Donostia University Hospital-Biodonostia Health Research Institute, Basque Country University, San Sebastián, Spain. 9. Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. 10. Gynecologic Oncology Unit, Hospital Universitario del Mar, Barcelona, Spain. 11. Gynecology Department, Hospital Universitario de Cruces, Bilbao, Spain. 12. Gynecology Department, Hospital Clinico Universitario Lozano Blesa, Saragossa, Spain. 13. Gynecology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 14. Gynecology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain. 15. Gynecologic Oncology Unit, 12 de Octubre Universitary Hospital, Madrid, Spain. 16. Gynecology Department, Hospital Universitario Son Espases, Majorca, Spain. 17. Gynecologic Unit, Donostia University Hospital-Biodonostia Health Research Institute, Basque Country University, San Sebastián, Spain. mikelgorostidi@icloud.com.
Abstract
BACKGROUND: This study aimed to review the current knowledge on the utility of intraoperative fluorescence imaging in gynecologic surgery and to give evidence-based recommendations to improve the quality of care for women who undergo gynecologic surgery. METHODS: A computer-based systematic review of the MEDLINE, CENTRAL, Pubmed, EMBASE, and SciSearch databases as well as institutional guidelines was performed. The time limit was set at 2000-2019. For the literature search, PRISMA guidelines were followed. A modified-Delphi method was performed in three rounds by a panel of experts to reach a consensus of conclusions and recommendations. RESULTS: Indocyanine green (ICG) is used primarily in gynecology for sentinel node-mapping. In endometrial and cervical cancer, ICG is a feasible, safe, time-efficient, and reliable method for lymphatic mapping, with better bilateral detection rates. Experience in vulvar cancer is more limited, with ICG used together with Tc-99 m as a dual tracer and alone in video endoscopic inguinal lymphadenectomy. In early ovarian cancer, results are still preliminary but promising. Indocyanine green fluorescence imaging also is used for ureteral assessment, allowing intraoperative ureteral visualization, to reduce the risk of ureteral injury during gynecologic surgery. CONCLUSIONS: For most gynecologic cancers, ICG fluorescence imaging is considered the tracer of choice for lymphatic mapping. The use of this new technology expands to a better ureteral assessment.
BACKGROUND: This study aimed to review the current knowledge on the utility of intraoperative fluorescence imaging in gynecologic surgery and to give evidence-based recommendations to improve the quality of care for women who undergo gynecologic surgery. METHODS: A computer-based systematic review of the MEDLINE, CENTRAL, Pubmed, EMBASE, and SciSearch databases as well as institutional guidelines was performed. The time limit was set at 2000-2019. For the literature search, PRISMA guidelines were followed. A modified-Delphi method was performed in three rounds by a panel of experts to reach a consensus of conclusions and recommendations. RESULTS: Indocyanine green (ICG) is used primarily in gynecology for sentinel node-mapping. In endometrial and cervical cancer, ICG is a feasible, safe, time-efficient, and reliable method for lymphatic mapping, with better bilateral detection rates. Experience in vulvar cancer is more limited, with ICG used together with Tc-99 m as a dual tracer and alone in video endoscopic inguinal lymphadenectomy. In early ovarian cancer, results are still preliminary but promising. Indocyanine green fluorescence imaging also is used for ureteral assessment, allowing intraoperative ureteral visualization, to reduce the risk of ureteral injury during gynecologic surgery. CONCLUSIONS: For most gynecologic cancers, ICG fluorescence imaging is considered the tracer of choice for lymphatic mapping. The use of this new technology expands to a better ureteral assessment.
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