PDF(Pubmed)
Abstract：
BACKGROUND: There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina® Lens system.
METHODS: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina® Lens for ICG fluorescence visualization.
RESULTS: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports.
CONCLUSIONS: Based on this initial experience, FGS using the Rubina® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.
METHODS: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina® Lens for ICG fluorescence visualization.
RESULTS: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports.
CONCLUSIONS: Based on this initial experience, FGS using the Rubina® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.
摘要：
背景：关于在开放手术领域中使用荧光引导手术（FGS）的论文很少。本研究旨在评估FGS在儿科人群开放环境中的有用性，并报告我们使用Rubina®Lens系统的初步经验。
方法：所有在2022年9月至2023年9月期间接受ICG荧光辅助开放手术的患者均被纳入。使用Rubina®透镜进行每个外科手术以进行ICG荧光可视化。
结果：共有25名患者，14名男孩和11名女孩，手术年龄中位数为5.8岁（0-15岁），已注册。手术指征为头皮样/表皮样囊肿（n=7），头/颈部淋巴管瘤（n=2），甲状舌管囊肿（n=7），男性乳房发育症（n=3），耳前瘘（n=2），第二branch裂瘘（n=1），肩纤维瘤（n=1）和臀区/会阴区肌纤维瘤（n=2）。在所有程序中,使用30号针头进行病灶内注射2.5mg/mLICG溶液.无ICG不良反应发生。中位手术时间为68.6分钟（范围35-189）。在所有情况下,使用Rubina®透镜实现ICG-NIRF的可视化。术中无并发症。术后并发症发生率为3/25(12%),男性乳房发育症（n=1），甲状舌管囊肿（n=1）和颈部淋巴管瘤（n=1），在手术部位收集了液体，在门诊治疗中需要针吸（Clavien-Dindo2）。完整肿块切除经病理报告证实。
结论：根据最初的经验，使用Rubina®镜片的FGS在开放手术中非常有帮助，提供增强的解剖可视化和边缘识别，实时可靠性和低并发症发生率。它很容易使用，节省时间,可行且临床安全。采用该技术需要MIS的先前经验。注射阶段的准确性对于避免ICG扩散到病灶周围组织中是重要的。
方法：所有在2022年9月至2023年9月期间接受ICG荧光辅助开放手术的患者均被纳入。使用Rubina®透镜进行每个外科手术以进行ICG荧光可视化。
结果：共有25名患者，14名男孩和11名女孩，手术年龄中位数为5.8岁（0-15岁），已注册。手术指征为头皮样/表皮样囊肿（n=7），头/颈部淋巴管瘤（n=2），甲状舌管囊肿（n=7），男性乳房发育症（n=3），耳前瘘（n=2），第二branch裂瘘（n=1），肩纤维瘤（n=1）和臀区/会阴区肌纤维瘤（n=2）。在所有程序中,使用30号针头进行病灶内注射2.5mg/mLICG溶液.无ICG不良反应发生。中位手术时间为68.6分钟（范围35-189）。在所有情况下,使用Rubina®透镜实现ICG-NIRF的可视化。术中无并发症。术后并发症发生率为3/25(12%),男性乳房发育症（n=1），甲状舌管囊肿（n=1）和颈部淋巴管瘤（n=1），在手术部位收集了液体，在门诊治疗中需要针吸（Clavien-Dindo2）。完整肿块切除经病理报告证实。
结论：根据最初的经验，使用Rubina®镜片的FGS在开放手术中非常有帮助，提供增强的解剖可视化和边缘识别，实时可靠性和低并发症发生率。它很容易使用，节省时间,可行且临床安全。采用该技术需要MIS的先前经验。注射阶段的准确性对于避免ICG扩散到病灶周围组织中是重要的。
