Indocyanine green (ICG) fluorescence imaging is widely used in gynecologic oncology to visualize lymphatic drainage and identify sentinel lymph nodes during cervical and endometrial cancer surgery. Proper dosing, injection site, and timing of ICG administration are critical to achieve reliable near-infrared fluorescence imaging and accurate lymphatic mapping.
This dosing guide outlines recommended ICG administration techniques for cervical and endometrial cancer procedures, including injection into the cervical submucosa and deep stromal tissue, dosage per quadrant, and expected fluorescence detection during sentinel lymph node mapping.
Administration of the dye should be performed at the level of the cervical submucosa, deep into the stroma. The dye should be distributed into 4 cervical quadrants.
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Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL):
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Yes
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Requires Flush with Sterile Water:
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No
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Proposed Dosage:
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1 mL
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Injection Time:
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Prior to dissection & insertion of uterine manipulator
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First Indocyanine Green Detection:
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At start of procedure
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Indocyanine Green Duration:
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Stable during surgery. Slowly diffuses through lymphatics
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Camera Requirements (handheld device, laparoscope or both):
Indocyanine green (ICG) fluorescence imaging is increasingly used during abdominal and pelvic surgery to assist in ureter localization and help prevent inadvertent ureteral injury. With near-infrared fluorescence imaging, surgeons can visualize ureteral pathways in real time, improving anatomical identification during complex surgical procedures.
This dosing and timing chart provides guidance on recommended ICG administration techniques for ureter localization, including injection methods, dosage considerations, and expected fluorescence detection timing to support safe and effective fluorescence-guided surgery.
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Title: Dosing & Timing Chart, Tabla:
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Purpose:
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Visualization of ureters
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Injection Type:
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Other
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Description:
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Cystoscopy guidance is recommended for retrograde intraureteral dye administration
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Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL):
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Yes
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Requires Flush with Sterile Water:
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No
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Proposed Dosage:
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5 mL per ureter
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Injection Time:
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Prior to pelvic dissection
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First Indocyanine Green Detection:
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During pelvic dissecction
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Indocyanine Green Duration:
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Remains stable during surgery
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Camera Requirements (handheld device, laparoscope or both):
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Both
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Tips & Tricks:
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Advance ureteral catheter to ensure comprehensive assessment of the ureteral course
Indocyanine green (ICG) fluorescence imaging is increasingly used in vulvar cancer surgery to visualize lymphatic drainage and identify sentinel lymph nodes. With near-infrared fluorescence imaging, surgeons can track lymphatic pathways in real time, improving sentinel lymph node detection and supporting more precise oncologic staging.
This dosing chart provides guidance on recommended ICG administration for vulvar cancer procedures, including peritumoral injection techniques, dosage per injection site, and expected fluorescence detection timing to optimize sentinel lymph node mapping during fluorescence-guided surgery.
Título del video: Ureter Identification in Complex Endometriosis
Chapter: EUROPEAN CHAPTER
Speakers: Manish Chand MD, PhD
Descripción: Dr. Manish Chand, discusses using retrograde ICG for ureter identification in complex endometriosis, with a multidisciplinary team approach of colorectal, urologic, and gynecologic surgeons.
Sven Mieog, Leiden University Medical Center, Leiden, NL
Karol Polom, Wielkopolska Cancer Center Poznań, Poznań, PL
Alexander Vahrmeijer, Leiden University Medical Center, Leiden, NL
Luigi Boni, IRCCS – Ca’ Granda, Policlinico Hospital of Milan, Milan, IT
During this course participants will obtain a thorough knowledge of the fundamentals and state-of-the-art applications of fluorescence imaging of tumours (primary, metastases, lymph nodes), sentinel lymph nodes and lymphatics, vital structures (bile ducts, ureters, nerves) and perfusion assessment of organs and tissues. Besides traditional fluorescent, fluorescent dyes, participants will discover and work with novel antibody-/peptide-/nanobody-based targeted fluorescence-guided surgical navigation. They will experience the possibilities and limitations of this intra-operative technique also in relation to open, laparoscopic and robotic approaches.
Open to
Oncologic surgeons, gynaecologists, urologists, thoracic surgeons, plastic and reconstructive surgeons, gastro-intestinal surgeons and vascular surgeons, researchers in the field of image-guided-surgery, and those who are in training for these medical specialties with an interest in the fundamentals and ap-plications of fluorescence-guided surgery.
Educational methods
Hands on session testing different fluorophores and fluorescencecontrast agents and their behaviour in different situations withvarious commercially available and experimental imaging systems.
Plenary lectures
Main topics
Fluorescence imaging of lymphatics & SLN
Fluorescence imaging of tissue perfusion
Imaging of biliary tract and ureters
Imaging of tumor tissue
Title: ESSO-ISFGS Course on Fluorescence-Guided Surgery
ISFGS Past Events
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Group Picture ESSO Fluorescentie
IMG 0770
Leiden, 6 June
Exciting day 1 of the course at the LUMC!We welcomed 70 participands from 13 countries for the ESSO-ISFGS course. Today was all about present-day usage of fluorescence guided surgery and hands-on learning. We kicked off with an in-depth exploration of fluorescence imaging...
Título del video: Applications of Fluorescence Guided Imaging in Gynecologic Surgery
Chapter: EUROPEAN CHAPTER
Speakers: Andrea Papadia
Descripción: The webinar describes common applications of fluorescence guided surgery in gynecologic with a special attention to the applications in the sentinel lymph node mapping for uterine cancers.
Applications of Fluorescence Guided Imaging in Gynecologic Surgery
EUROPEAN CHAPTER
Andrea Papadia
The webinar describes common applications of fluorescence guided surgery in gynecologic with a special attention to the applications in the sentinel lymph node mapping for uterine cancers.
10-03-2021
Título del video: Gynecological Uses of Fluorescent Guided Imaging Using ICG
Speakers: Maria Hincapie, Ceana Nezhat
Descripción: This video portrays the applications of fluorescence technology in laparoscopic and robotic surgery. Special attention is placed on specific steps for preparation of indocyanine green (ICG) and its use in sentinel lymph node biopsy, ureter identification, endometriosis lesion mapping and bowel resection and anastomosis.
Gynecological Uses of Fluorescent Guided Imaging Using ICG
This video portrays the applications of fluorescence technology in laparoscopic and robotic surgery. Special attention is placed on specific steps for preparation of indocyanine green (ICG) and its use in sentinel lymph node biopsy, ureter identification, endometriosis lesion mapping and bowel resection and anastomosis. Suggested complementary reading: Nezhat CH, Odunsi T. Intelligent light and florescence-guided surgery augmenting the surgeon's visual perception. Fertil Steril. 2020 Nov;114(5):980. doi:...
