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DEVELOPMENT OF NEAR-INFRARED FLUORESCENCE IMAGING SYSTEM AND ITS USE FOR SENTINEL LYMPH NODE MAPPING USING INDOCYANINE GREEN IN WOMEN WITH CERVICAL AND UTERINE CANCERS
Fluorescence imaging systems have been used to guide surgical and diagnostic procedures and have become widespread with their availability coupled with minimally invasive laparoscopic and robotic surgical equipments. However, the need for specific systems has limited and hampered the use of this technique in open field procedures.
To describe the development of the Easy Light device and to present the preliminary results of its clinical use.
We developed an open-field handheld wireless device named Easy Light to allow real-time visualization of ICG fluorescence in common smartphones and tablets using a pre-installed application software. Proof-of-concept experiments were first performed applying the ICG dye in fresh chicken wings and then, performing ex-vivo evaluations of fresh surgical specimens removed during robotic surgeries in which a sentinel lymph node biopsy was performed. The clinical evaluation comprised an early feasibility study involving patients with uterine cancer who underwent sentinel lymph node mapping via conventional open surgery (CAAE: 45814621.5.0000.5201, NCT05004623).
We conceptualized a rechargeable device with electronic and optical parts acquired from online markets and assembled into a pistol-shaped case. Pre-clinical tests demonstrated proper visualization of the ICG fluorescence in both the fresh chicken wings and in the fresh surgical specimens (i.e.: ex-vivo examination of utherus plus sentinel lymph nodes) removed by robotic surgery in women with endometrial cancer. For the clinical evaluation, five patients with stage I to II cervical (n=2) or endometrial (n=3) cancers were recruited to participate with a medidan (range) of BMI and age of 28.7 kg/m2 (25 – 35,4) and 66 years (29 – 68), respectively. Intraoperative detection of at least one sentinel node was possible for all of these patients, with bilateral detection in 2 of them. Ex-vivo exams of the surgical products of a full lymph node dissection performed for the hemipelvis in which the sentinel lymph node was not detected confirmed the absence of any fluorescent dye (i.e.: it were a failures of the ICG migration through the lymphatics vessels and not a detection failure itself).
The Easy Light system proved to be a suitable tool for fluorescence-guided procedures. It potentially represents an user-friendly and low-cost system that may help to democratize the use of fluorescence lighting in targeted open-field procedures.
Optical Imaging; Indocyanine Green; Sentinel Lymph Node Biopsy.
DUILIO COSTA NETO COSTA-NETO, CATARINA ANDRADE MOREIRA SOUZA, MATHEUS VASCONCELOS AQUINO, DIOGENES FERNANDO SANTOS FONTÃO, VANDRÉ CABRAL GOMES CARNEIRO, ANTONIO CAVALCANTI DE ALBUQUERQUE MARTINS, CRISTIANO SOUZA LEÃO, AVISHEK DAS, ANDERSON STEVENS LEÔNIDAS GOMES, THALES PAULO BATISTA