The use of a microscope with near-infrared imaging function in indocyanine green lymphography and lymphaticovenous anastomosis.

Abstract

Indocyanine green (ICG) lymphography has become an important investigation in lymphaticovenous anastomosis (LVA). Near-infrared (NIR) imaging systems are available in the market for the production of ICG lymphography. These machines, however, may be difficult to obtain owing to their costs. In our institute, these NIR imaging devices are not available. Alternatively, microscopy with NIR imaging function was used for LVA. The experiences of the production of ICG lymphography with an NIR microscope are described. For the production of preoperative ICG lymphography, ICG solution was injected subdermally to the web spaces of the lymphoedema limb. The NIR mode of the microscope was used for the lymphatic mapping. Black and white images and videos of the ICG lymphography were then produced. Intra-operatively, the NIR function was used for the localisation of lymphatic vessels and confirmation of the patency of the LVA. Between February 2013 and May 2013, 24 ICG lymphographies were performed in 20 female patients as a preoperative investigation for LVA. All four ICG lymphography patterns (linear, splash, stardust and diffuse patterns) were demonstrated. In institutes where NIR imaging devices are not available, we believe that a microscope with an NIR imaging function is a reasonable alternative for the production of ICG lymphography.