Use of fluorescence to guide surgical resection in vulvo-vaginal neoplasia: Two case reports - 12/05/21

Doi : 10.1016/j.jogoh.2020.101768

Huyen-Thû Nguyen-Xuan ^a,^b, Rosa Montero Macias ^a,^b, Hélène Bonsang-Kitzis ^c, Myriam Deloménie ^d, Charlotte Ngô ^c, Meriem Koual ^a,^b, Anne-Sophie Bats ^a,^b, Mickael Hivelin ^e, Fabrice Lécuru ^b,^f, Vincent Balaya ^a,^b,^⁎
^a Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France
^b Paris University, Faculty of Medicine, Paris, France
^c Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, Paris, France
^d Institute Français du sein, Paris, France
^e Plastic and Reconstructive Surgery Department, Ambroise Paré Hospital, Boulogne-Billancourt, France
^f Breast, Gynecology and Reconstructive Surgery Department, Curie Institute, Paris, France

^⁎Corresponding author at: Service de Chirurgie Cancérologique, Gynécologique et du Sein, Hôpital Européen Georges Pompidou 20, rue Leblanc, 75908 Paris Cedex 15, France.Service de Chirurgie CancérologiqueGynécologique et du SeinHôpital Européen Georges Pompidou 20rue LeblancParis Cedex 1575908France

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Abstract

We report hereby two cases of fluorescence-guided surgical resection with Indocyanine green in vulvo-vaginal neoplasia. The first case was a 86-year old patient who had a high-grade squamous intraepithelial lesion of the left small lip and on the vulvar fork. After a first incomplete surgery, a second fluorescence-guided vulvectomy was performed with ICG injected intravenously to determine intraoperatively surgical margins. At final pathologic examination, surgical margins were free of disease and postoperative course was uneventful. The second case was a 44-year old patient who had a clear cell carcinoma of the upper vagina. She underwent a fluorescence-guided colpo-hysterectomy with pelvic lymphadenectomy. ICG was injected one centimeter around the tumor and highlighted intraoperatively the limits of the vaginal resection. On the specimens, surgical margins were also negative. Peritumoral or intravenous injection of ICG are promising techniques for the intraoperative identification of surgical margins in gynecologic malignancies.

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Keywords : Fluorescence-guided surgery, Gynecologic oncology, Vulvar cancer, Vaginal cancer, Indocyanine green