Abstract
Introduction:
The use of indocyanine green (ICG) in fluorescence-guided lymph node mapping is beneficial for detecting and harvesting lymph nodes in various forms of cancer, including breast cancer and gynecologic cancer. 1 There has been limited research on its application in thyroid tumors, and ICG spillage during injection is a frequently encountered problem.2,3 We present a video of transoral endoscopic thyroidectomy using ICG as an adjunct for the mapping and harvest of lymph nodes.
Materials and Methods:
This study included two patients who underwent transoral endoscopic thyroidectomy for suspected thyroid cancer. Preoperative imaging showed no evidence of lymph node involvement. Preincisional ICG injection was performed under ultrasound guidance. Prelaryngeal (Delphian), pretracheal, and paratracheal ICG-uptake nodes were identified and removed during surgery.
Results:
ICG was administered in both cases without leaking into the surrounding tissues. Under fluorescence, the prelaryngeal and pretracheal nodes were detected and removed in patient 1. ICG enhancement was not observed in the paratracheal region. The final pathologic diagnosis was papillary carcinoma with lymph node metastasis. Four of the six harvested lymph nodes were positive, and the largest size of the metastatic deposit was 5.5 mm. Patient 1 received adjuvant radioactive iodine therapy (100 mCi), and no additional positive node was detected in the post-treatment radioiodine scan. Only one paratracheal node was stained with ICG in patient 2. Pathologic examination revealed a noninvasive follicular thyroid neoplasm with papillary-like nuclear features and reactive lymphadenopathy.
Conclusions:
The fluorescence-guided mapping of lymph nodes is a feasible adjunct to transoral endoscopic thyroidectomy. The delivery of ICG can be achieved using ultrasound guidance through preincisional injection.
Patient Consent:
Authors have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.
No competing financial interests exist
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Runtime of video: 8 mins 40 secs
Keywords
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