Identification of lymphatic pathway involved in the spread of bladder cancer: Evidence obtained from fluorescence navigation with intraoperatively injected indocyanine green
Introduction: We identify lymphatic vessels draining from the bladderby using fluorescence navigation (FN) system.
Methods: In total, 12 candidates for radical cystectomy and pelviclymph node dissection (PLND) were included in this study. Afteran indocyanine green (ICG) solution was injected into the bladderduring radical cystectomy, lymphatic vessels draining from thebladder were analyzed using a FN system. PLND was based onthe lymphatic mapping created from the FN measurements (in vivoprobing) in the external iliac, obturator and internal iliac regions;after PLND, the fluorescence of the removed lymph nodes (LNs)was analyzed on the bench (ex vivo probing).
Results: There were no patients with complications associated withthe intravesical ICG injection. A lymphatic pathway along inferiorvesical vessels to internal iliac LNs was clearly illustrated in 7 cases.Under in-vivo probing, the fluorescence intensity of internal iliacnodes was greater than that of external iliac or obturator nodes.Under ex-vivo probing, the fluorescence intensity of internal iliacand obturator nodes was greater than that of external iliac nodes.
Conclusions: Using an FN system after injecting ICG during a radicalcystectomy operation is a safe and rational approach to detectingthe lymphatic channel draining from the bladder.
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