Total Laparoscopic Hysterectomy
with bilateral salpingo-oophorectomy and staging with omentectomy and sentinel lymph node dissection using ICG imaging
00:05 Surgical planning
13:18 Omentum biopsy
- 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.
3D anatomy model
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- Persson, J., Geppert, B., Lönnerfors, C., Bollino, M., & Måsbäck, A. (2017). Description of a reproducible anatomically based surgical algorithm for detection of pelvic sentinel lymph nodes in endometrial cancer. Gynecologic oncology, 147(1), 120-125.
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- Kostov, S., Slavchev, S., Dzhenkov, D., Mitev, D., & Yordanov, A. (2020). Avascular Spaces of the Female Pelvis—Clinical Applications in Obstetrics and Gynecology. Journal of Clinical Medicine, 9(5), 1460.