Total Laparoscopic Hysterectomy

with bilateral salpingo-oophorectomy and staging with omentectomy and sentinel lymph node dissection using ICG imaging

00:05  Surgical planning

02:55  ICG injection and port placement

04:32  Sentinel lymph node dissection

10:33  Bilateral salpingo-oophorectomy

11:53  Hysterectomy

13:18  Omentum biopsy

13:39  Closure

Case Description
  • UHN Gynecologic Oncology
  • The patient was a 66 year old woman with a high grade endometrial cancer on endometrial biopsy.
  • The patient had a previous bilateral tubal ligation.
  • A total laparoscopic hysterectomy (TLH) with bilateral salpingo-oophorectomy and sentinel lymph node staging was planned.
  • Indocynine Green (ICG) fluorescence dye will be used throughout the procedure to visualize the lymphatics.
  • A 25-mg vial of ICG will be reconstituted in 10 mL of sterile water (2.5 mg/mL) and drawn into a spinal needle.
  • The ICG dye will then be injected into the patient’s cervix at the 3- and 9-o'clock positions with 0.5 mL of ICG superficially, at 1- to 2-mm depth, and 0.5 mL of ICG at 10-mm depth, for a total dose of 2 mL of ICG.
  • ICG will be used to identify the sentinel lymph nodes (SLN) for resection bilaterally.
  • The most common area for the sentinel lymph node is the proximal obturator space bilaterally, also known as the lateral paravesical space.
  • The main 10mm camera port will be placed in the umbilicus, and a 10mm suprapubic port in the centreline, just above the pubic symphysis.
  • Two 5-mm operating ports will be placed in the right, and left lower quadrants.
CT scans

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3D anatomy model

Gynecologic surgical anatomy by TVASurg on Sketchfab

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