ASO Author Reflections: Fluorescence-Guided Surgery in Gynecology Becomes a Standard
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Fluorescence-Guided Surgery in Gynecology Becomes a Standard Mikel Gorostidi, MD, MS, PhD1
, and Ignacio Zapardiel, MD, PhD2
1
Gynecologic Oncology Unit Osakidetza, Donostia University Hospital/Biodonostia Health Research Institute, Basque Country University, San Sebastian, Spain; 2Gynecologic Oncology Unit, La Paz University Hospital/IdiPAZ, Madrid, Spain
PAST Kodak Research Laboratories implemented the use of fluorescence in photography during World War II. Thereafter, nephrologists, ophthalmologists, and cardiologists began to use it in medicine after its approval by the FDA in 1959 for retinal angiography and intravenous use.1 In gynecology, it was first used to detect sentinel nodes in vulvar cancer,2 which helped to establish the positive impact of lymphatic drainage preservation on morbidity. After this first use, fluorescence imaging was incorporated into the detection of sentinel nodes in cervical and endometrial cancer with very good acceptance among gynecologic surgeons. PRESENT The most widely used tracer is indocyanine green (ICG), which allows easy intraoperative visualization of lymphatic channels and nodes. This has led to an increase in bilateral detection rates of sentinel nodes in cervical and endometrial cancer,3,4 while its use in ovarian cancer remains experimental. Moreover, the precise intraoperative navigation through the lymphatic system could make some procedures, such as paraaortic lymphadenectomy, safer and more selective.
Ó Society of Surgical Oncology 2020 First Received: 25 September 2020 Accepted: 27 September 2020 M. Gorostidi, MD, MS, PhD e-mail: [email protected]
In the consensus paper on ICG and fluorescence elaborated by a group of Spanish gynecologic surgeons,5 a very interesting ICG application for ureteral identification is described. Its instillation inside the ureters by cystoscopy seems to make complex interventions, such as deep endometriosis or radical hysterectomy, easier and safer; this is possible due to the potential to reduce the risk of surgical complications and postoperative-associated morbidity. FUTURE We have no doubt that ICG will replace all current tracers used in gynecologic surgery and that all centers will routinely use this technology. We can imagine a future where the improved visualization of anatomical structures and the intraoperative-guided navigation, thanks to the use of fluorescence imaging technology, will improve and facilitate surgeons’ technique and final outcomes. Additionally, its increasing use for organ vascularization seems to expand the applicability of ICG for advanced gynecologic surgery. DISCLOSURES
Both authors have no disclosures.
REFERENCES 1. Abu-Rustum NR, Angioli R, Bailey AE, Broach V, Buda A, Coriddi MR, et al. IGCS Intraoperative technology taskforce. Update on near infrared imaging technology: beyond white light and the naked eye, indocyanine green and near infrared technology in the treatment of gynecologic cancers. Int J Gynecol Cancer. 2020;30(5):670–83. ht
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