Total laparoscopic hysterectomy with ICG imaging - TVASurg

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.