Advanced Diagnostic Technology

Say Goodbye to Compression Garments after Dr. Cheng’s Lymphedema Microsurgery

Indocyanine Green (ICG) Lymphography

What is ICG lymphography?

Indocyanine green (ICG) is a green colored dye. It binds to albumin (a kind of protein), which is transported within the lymph fluid. ICG has been used to test blood flow after being injected intravenously and has also been used to show lymphatics after low dose injection to the subcutaneous tissue. ICG lymphography uses a specialist infra-red camera to detect low dose injected ICG dye in the subcutaneous tissue with the depth of 10 mm. The lymphatic function can be checked on a screen during the scan.

What does ICG lymphography image look like?

Normal function of lymphatic system:

After ICG is injected, it will quickly be taken by the lymphatics and transported in the lymphatic tubular duct as a linear lymphatic vessel (linear fluorescence). When functioning normally, the fluid and dye will rhythmically push up the lymph proximally.

In lymphedema limb:
In lymphedema limb, the one-way perfusion may be stuck. The lymphatic fluid remains in lymphatics, and the structure of the lymphatic duct will gradually be dilated, fibrotic then obstructed. As lymphedema progresses, the fluid will leak into subcutaneous tissue, causing dermal backflow (star-like fluorescence).

At Chang Gung Memorial Hospital, we are grad that we have 3 kinds of up-to-date ICG devices for the detection of lymphatic ducts at Clinic or Ward (ADRONIC or Fluobeam 800), and for the evaluation of the patent lymphatic ducts and patency preoperatively of lymphovenous anastomosis intraoperatively at operation room (Spy Elite).

”ADRONIC” ICG

Indocyanine Green (ICG) Lymphography - Osler 2000 (Chang Gung Medical Company, Inc.)
Indocyanine Green (ICG) Lymphography - Osler 2000
ICG-1
  • “ADRONIC” Fluorescence Imaging System is a fluorescent image photography device, so that the surgeon can shoot, review, store high-quality fluorescent image device.
  • “ADRONIC” Fluorescence Imaging System is used with fluorescent developer “Indocyanine Green” (Indocyanine Green). Including lymphatic vessels and blood vessels, as well as related applications during a variety of surgical procedures. Infrared transmitter can be controlled by the professional staff to adjust the distance or set up in the top of the camera to facilitate the operation, video recording can be immediately after the completion of the replay to review.
  • Model: Adronic ICG
    • Independent imaging with 3.5 inch screen
    • Able to snapshot and record video
    • Provides doctors with accurate location of vessel and lymph

Case Sharing

Breast cancer is a very common malignant tumor that women often experience. The number of cases is increasing over the years. In addition, it can seriously threaten women’s physical and mental health. Surgery and operation are still the common treatment that doctors use. However, it can cause detrimental complications to the human body. For example, upper limb lymphedema, bring great pain to the patient and seriously affects the quality of life of the patient.

Doctor Cheng Ming-Huei, authority in plastic surgeon and ex-director of Linkou Chang Gung Memorial Hospital, metioned that the fluorescence spectrum lymphangiography of ICG Video Scope can be used in breast cancer, breast augmentation and breast reduction. It brings applications to future clinical studies and reduces the recovery time needed after surgery. It also avoids the waste of medical resources due to the lower possibility of relapse.

Features of ICG Video Scope

  • Monitors edema of lymph in flaps
  • Monitors the Lymphatic reconstruction and the recanalization
  • Distinguishes different lymph drainage of breast and upper limb to decrease the possibility of Lymphedema after surgery
  • Monitors the different pathological changes of muscle by the patients with Lymphedema
  • The Fluorescence Imagining system is highly sensitive and provides reliability to the examination of Vessel Lymphedema

Mitaka Microscope & Zeiss Pentero 900-Microscope

Mitaka

ZEISS PENTERO 900-MICROSCOPE

The Mitaka Surgical Microscope is high resolution at 160 line-pairs per millimeter and 42x, making it ideal for working in the sub-1mm environment.

Fluobeam® 800

Indocyanine Green (ICG) Lymphography - Fluobeam® 800 (picture)

Indocyanine Green (ICG) Lymphography - Fluobeam® 800

Spy Elite

Indocyanine Green (ICG) Lymphography - SPY ELITE (machine)

SPY Elite, a fluorescent imaging system, may be used by surgeons to help determine whether certain tissues in the body have a strong enough blood supply for transplant purposes.  Analyzing the blood circulation of tissues throughout the body may help our surgeons identify healthy donor tissue that may be harvested for such purposes, or compare the viability of various donor sites they are considering.

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