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首页> 外文期刊>Gynecologic Oncology Reports >Left paraaortic, inframesenteric lymphadenectomy preserving the superior hypogastric plexus supported by indocyanine green (ICG) labeling of the lymphatic compartment in cervical cancer
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Left paraaortic, inframesenteric lymphadenectomy preserving the superior hypogastric plexus supported by indocyanine green (ICG) labeling of the lymphatic compartment in cervical cancer

机译：左主动脉旁，肋间肌淋巴结清扫术保留了子宫颈癌淋巴室的吲哚菁绿（ICG）标记支持的下胃下神经丛

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Superior hypogastric plexus (SHG) contains mainly sympathetic and most probably also postganglionic parasympathetic fibers. Thus, surgical damage of SHG may cause autonomic pelvic organ dysfunction (). As already shown for rectal cancer, preservation of the autonomic nerves is facilitated by robotic surgery and may avoid sexual dysfunctions and voiding disorders (). In this educational video, we demonstrate left lower paraaortic lymph node dissection preserving the SHG using ICG fluorescence to label the lymphatic compartment. Prior to total mesometrial resection (TMMR) with therapeutic lymphadenectomy for cervical cancer () 4 × 0.5 ml of a 1.66 mg/ml Indocyanine green solution (ICG Pulsion?, PMS SE, Feldkirchen, Germany) was injected into the uterine cervix at all four quadrants, 0.5 cm in depth (). The lymphatic network of the downstream common iliac and inferior paraaortic lymph compartments of the uterine cervix is visualized (ICG fluorescence) including the individual connecting vessels between the different compartments. As can be demonstrated, the medial upper common iliac (subaortic) compartment drains preferentially into the anterior (mesenteric) compartment, whereas lateral common iliac lymphatic vessels mainly drain to the posterior (lumbar) paraaortic compartment. The autonomic nerve fibers of the SHP may easily be identified and preserved due to the excellent image resolution and the discrimination from fluorescent lymphatic structures. The video shows the preparation of left lower paraaortic nodes in cervical cancer following ICG labeling using a da Vinci Xi system?. This technique seems not only advantageous for preserving SHP, but even more highly educational to learn surgical anatomy for trainees. Highlights ? ICG fluorescence marks lymphatic downstream compartments in cervical cancer. ? ICG labeling to discriminate lymphatic compartment from superior hypogastric plexus ? Fluorescence based HD-video documentation for education in lymphadenectomy.
机译：上胃下丛（SHG）主要包含交感神经纤维，最可能还包含节后副交感神经纤维。因此，SHG的手术损害可能会导致植物神经盆腔功能障碍（）。如针对直肠癌已显示的那样，机器人手术有助于保护自主神经，并可以避免性功能障碍和排尿障碍（）。在这个教育视频中，我们展示了左下主动脉旁淋巴结清扫术，使用ICG荧光标记的淋巴区保留了SHG。在用全淋巴结清扫术（TMMR）进行治疗性宫颈癌的淋巴结清扫术之前，将4×0.5 ml的1.66 mg / ml吲哚菁绿溶液（ICG Pulsion？，PMS SE，Feldkirchen，德国）注入所有四个子宫颈象限，深度0.5厘米（）。可以看到子宫子宫颈下游common总和下主动脉旁淋巴区的淋巴网络（ICG荧光），包括不同区室之间的各个连接血管。可以证明，内侧upper总上（潜流）区优先排入前（肠系膜）区，而外侧lateral总淋巴管主要排至后（腰）副主动脉区。由于出色的图像分辨率和与荧光淋巴结构的区别，SHP的自主神经纤维很容易被识别和保存。视频显示使用da Vinci Xi系统在ICG标记后准备子宫颈癌左下腹主动脉结。这项技术似乎不仅有利于保存SHP，而且对受训者的手术解剖学也更具教育意义。强调 ？ ICG荧光标记宫颈癌的淋巴下游区室。 ？ ICG标记可区别上胃下神经丛的淋巴室？基于荧光的高清视频文档，用于淋巴结清扫术的教育。

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