Luigi Boni

Real-time Intraoperative Fluorescent Lymphography: A New Technique for Lymphatic Sparing Surgery

BACKGROUNDnMany surgical procedures can produce persistent lymphorrhea, lymphoceles, and lymphedema after lymph node and lymph vessel damage. Appropriate visualization of the lymphatic system is challenging. Indocyanine green (ICG) is a well-known nontoxic dye for lymphatic flow evaluation. ICG fluorescence-guided lymphography has emerged as a promising technique for intraoperative lymphatic mapping.nnnOBJECTIVEnOur goal was to develop a high spatial resolution, real-time intraoperative imaging technique to avoid or recognize early deep lymphatic vessel damage.nnnMETHODSnWe intraoperatively performed ICG fluorescence-guided lymphography during a kidney transplant. ICG was injected in the subcutaneous tissue of the patients groin in the Scarpas triangle. A dedicated laparoscopic high-definition camera system was used.nnnRESULTSnSoon after ICG injection, the lymphatic vessels were identified in the abdominal retroperitoneal compartment as fluorescent linear structures running side by side to the iliac vessels. Surgical dissection was therefore performed, avoiding iatrogenic damage to major lymphatic structures. Another ICG injection at the end of the procedure confirmed that the lymphatic vessels were intact without lymph spread.nnnCONCLUSIONSnIntraoperative lymphatic mapping with an ICG fluorescence-sensitive camera system is a safe and feasible procedure. ICG real-time fluorescence lymphography can be used to avoid or recognize early deep lymphatic vessel damage and reduce postoperative complications related to the lymphatic system.

Concomitant Abdominal Aortic Aneurysm and Malignancy: Simultaneous Minimally Invasive Repair

Gabriele Piffaretti1, Luigi Boni2, Matteo Tozzi1, Nicola Rivolta1, Giovanni Mariscalco3 and Patrizio Castelli1 1Vascular Surgery – Department of Surgical Sciences, University of Insubria School of Medicine, Varese 2General Surgery 1 – Department of Surgical Sciences, University of Insubria School of Medicine, Varese 3Cardiac Surgery – Department of Surgical Sciences, University of Insubria School of Medicine, Varese, Italy