Utility of Intraoperative Fluorescence Imaging in Gynecologic Surgery: Systematic Review and Consensus Statement
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CONTINUING EDUCATION– GYNECOLOGIC ONCOLOGY
Utility of Intraoperative Fluorescence Imaging in Gynecologic Surgery: Systematic Review and Consensus Statement Ignacio Zapardiel, MD, PhD1, Julio Alvarez, MD2, Manel Barahona, MD3, Pere Barri, MD4, Ana Boldo, MD5, Pera Bresco, MD6, Isabel Gasca, MD7, Ibon Jaunarena, MD8, Ali Kucukmetin, MD9, Gloria Mancebo, MD10, Borja Otero, MD11, Fernando Roldan, MD12, Ramo´n Rovira, MD13, Enma Suarez, MD14, Alvaro Tejerizo, MD, PhD15, Anna Torrent, MD16, and Mikel Gorostidi, MD, MS, PhD8 1
Gynecologic Oncology Unit, La Paz University Hospital–IdiPAZ, Madrid, Spain; 2Obstetrics and Gynecology Department, Infanta Sofia University Hospital, Madrid, Spain; 3Gynecology Department, Puerto Real University Hospital, Ca´diz, Spain; 4Gynecologic Surgery Unit, Hospital Quiron Dexeus, Barcelona, Spain; 5Obstetrics and Gynecology Department, Hospital de la Plana, Castello´n, Spain; 6Gynecology Department, Hospital de Igualada, Barcelona, Spain; 7 Gynecology Department, Hospital de Valme, Seville, Spain; 8Gynecologic Unit, Donostia University Hospital– Biodonostia Health Research Institute, Basque Country University, San Sebastia´n, Spain; 9Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK; 10Gynecologic Oncology Unit, Hospital Universitario del Mar, Barcelona, Spain; 11Gynecology Department, Hospital Universitario de Cruces, Bilbao, Spain; 12Gynecology Department, Hospital Clinico Universitario Lozano Blesa, Saragossa, Spain; 13Gynecology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 14Gynecology Department, Hospital Universitario Vall dHebron, Barcelona, Spain; 15Gynecologic Oncology Unit, 12 de Octubre Universitary Hospital, Madrid, Spain; 16Gynecology Department, Hospital Universitario Son Espases, Majorca, Spain
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 visualiz
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