Lymphatic drainage of the ovaries; Fluorescence image-guided exploration = Lymphatic drainage of the ovaries; Fluorescence image-guided exploration

다국어 초록 (Multilingual Abstract)

Objective: 3. Demonstrate a new instrument, technique or procedure
Target: 2. Adanced practicioners
Methods: The patient was 55 years old female who was diagnosed with right ovarian mass. In preoperative transvaginal ultrasound, about 7cm-sized hypoechoic right adnexal mass was found and tumor markers were within normal range (CA 125 : 10.3 U/mL, CA 19-9 : 19.3 U/mL). Single-port assisted diagnostic laparoscopy was done. There was 7cm-sized cystic mass at right adnexa. Diluted ICG solution (concentration: 1.25mg/mL) was prepared with injection needle (0.7mm needle tip, 330mm working length, 5mm diameter, 20mm needle length, code no. 300-194-307, RZ Mediz-intechnik GmbH, Tuttlingen, Germany). Through the single-port which located at umbilicus, ICG was directly injected on the ovarian cortex (each 2mL, 0.5cm depth). After 15 minutes later, ovarian lymphatic flow was checked with near-infrared fluorescence laparoscopy in real time. After the exploration of ovarian lymphatic flow, single-port assisted laparoscopic bilateral salpingo-oophorectomy was followed.
Results: After 15 minutes later, the right ovarian lymphatics was drained from the right IP ligament to the right aortocaval lymph nodes. Unlike lymphatic drainage of the right ovary, the left ovarian lymphatics drained directly to the left upper para-aortic lymph nodes between the left renal vein and the inferior mesenteric artery. There were no identified lymph nodes between the Lt IP ligament and the upper para-aortic area.
Conclusion: In this patient, bilateral ovarian sentinel lymph nodes were detected at the right aortocaval area and the left upper para-aortic area. The lymphatic drainage of the ovary was appeared to be along with the ovarian vessels.