V4-02: LAPAROSCOPIC RADICAL PROSTATECTOMY IN INTERMEDIATE AND HIGH RISK PROSTATE CANCER. INDOCYANINE GREEN-GUIDED PELVIC LYMPH NODE DISSECTION.
VideoIntroductions and Objectives
INTRODUCTION _x000D_ Knowledge of the precise lymph drainage anatomy for each prostate, allowing a perfect lymph node dissection (LND), would be of great clinical relevance. Indocyanine Green may be of great value in this scenario, by accurately highlighting the nodes and guiding the LND. _x000D_ _x000D_ OBJECTIVE_x000D_ We present a video of an Indocyanine Green-guided LND in a high-risk prostate cancer patient. _x000D_ We present the preliminary results from an exploratory study involving 22 consecutive patients undergoing ICG-guided LND.
The procedure begins with the ultrasound guided transperineal injection of Indocyanine Green (25mg in 5ml of water solution). After few minutes, w e performed a laparoscopic LND guided by the ICG induced fluorescence of lymph channels and nodes. _x000D_ _x000D_ Image 1 SPIES TM with Hopkings® 0º optic, H3-LINK ™ and H3-Z FI SPIES™ Camara is used for the surgery. _x000D_ Nodes are independently coded depending on their anatomical location. The procedure is completed with a extended LND up to the crossing of the ureter and the Iliac vessels, including pre-sacral nodes and later the laparoscopic radical prostatectomy. _x000D_ Preliminary data on sensibility and specificity and initial results from our early experience are detailed at the end of the video.
In our initial experience, a mean number of 6 ICG+ nodes were identified, with an average of 22.27 nodes per procedure. Lymph node metastasis were found in 36,4% of patients and metastasis in ICG+ nodes were present in all of them. Hence, no false negatives were found. Thirty-seven out of the 490 nodes studied, 37 were positive, whereas, 27 out of the 142 ICG+ nodes were metastasic. Sensibility, specificity and NPV were 73%, 74.6% and 97.13%, respectively.
ICG-guided pelvic LND is robust, reliable and reproducible. It is inexpensive and relatively quick procedure, allowing a reliable delineation of the lymph vessels and nodes. Furthermore, its high NPV would suggest that an extended LND could potentially be avoided if frozen section of the ICG+ nodes is negative.
Funding: None._x000D_ _x000D_ ACKNOWLEDGEMENT: Karl Storz.