Treatment of a Large, Symptomatic Refractory Lymphocele After Pelvic Lymphadenectomy by Using the Hypereye Medical System™

Abstract

Background: A 74-year-old Japanese woman with a refractory lymphocele after pelvic lymphadenectomy is presented. Case: A woman with a borderline malignant ovarian tumor (stage IIIa) underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and partial omentectomy. After the operation, she complained of difficulty with defecation and lower abdominal pain. These symptoms were considered to originate from a large lymphocele in the right pelvis. Repeated percutaneous drainage of this pelvic lymphocele was performed 19 times within 1 year. However, the cyst did not decrease in size. Therefore, it was decided to treat the lymphocele surgically. The HyperEye Medical System TM (HEMS) for detecting lymph vessels with indocyanine green (ICG) fluorescence and near-infrared light was used. After injection of ICG in the patient's ankle, the dye reached the inguinal region and was detected in the base of the lymphocele and could ligate this lymphatic inflow. Results: After the treatment, no recurrence of the lymphocele was seen for >16 months. Conclusions: This new method may be able to cure a refractory lymphocele by detecting and ligating the feeding lymph vessel under near-infrared light using the HEMS. This method may be established as a new treatment for refractory lymphocele after pelvic lymphadenectomy. ( J GYNECOL SURG 31:61)