TY - JOUR
T1 - Use of fluorescence imaging during lymphatic surgery
T2 - a Delphi survey of experts worldwide
AU - Dip, Fernando
AU - Alexandru, Nistor
AU - Amore, Miguel
AU - Becker, Corinne
AU - Belgrado, Jean Paul
AU - Bourgeois, Pierre
AU - Chang, Edward I.Fei
AU - Koshima, Isao
AU - Liberale, Gabriel
AU - Masia, Jaume
AU - Mortimer, Peter
AU - Neligan, Peter
AU - Batista, Bernardo Nogueira
AU - Olszewski, Waldemar
AU - Salvia, Sophia Alexia
AU - Suami, Hiroo
AU - Vankerckhove, Sophie
AU - Yamamoto, Takumi
AU - Lo Menzo, Emanuele
AU - White, Kevin P.
AU - Rosenthal, Raul J.
N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Fluorescence imaging with indocyanine green is increasingly used during lymphedema patient management. However, to date, no guidelines exist on when it should and should not be used or how it should be performed. Our objective was to have an international panel of experts identify areas of consensus and nonconsensus in current attitudes and practices in fluorescence imaging with indocyanine green use during lymphedema surgery patient management. Methods: A 2-round Delphi study was conducted involving 18 experts in the use of fluorescence imaging during lymphatic surgery, all asked to vote on 49 statements on patient preparation and contraindications (n = 7 statements), indocyanine green dosing and administration (n = 10), fluorescence imaging uses and potential advantages (n = 16), and potential disadvantages and training needs (n = 16). Results: Consensus ultimately was reached on 40/49 statements, including consistent consensus regarding the value of fluorescence imaging with indocyanine green in almost all facets of lymphedema patient management, including early detection, assessing disease extent, preoperative work-up, surgical planning, intraoperative guidance, monitoring short- and longer-term outcomes, quality control, and resident training. All experts felt it was very safe, while 94% felt it should be part of routine care and that indocyanine green was superior to colored dyes and ultrasound. Nonetheless, there also was consensus that limited high-quality evidence remains a barrier to its widespread use and that patients should still be provided with specific information and asked to sign specific consent for both fluorescence imaging and indocyanine green. Conclusion: Fluorescence imaging with or without indocyanine green appears to have several roles in lymphedema prevention, diagnosis, assessment, and treatment.
AB - Background: Fluorescence imaging with indocyanine green is increasingly used during lymphedema patient management. However, to date, no guidelines exist on when it should and should not be used or how it should be performed. Our objective was to have an international panel of experts identify areas of consensus and nonconsensus in current attitudes and practices in fluorescence imaging with indocyanine green use during lymphedema surgery patient management. Methods: A 2-round Delphi study was conducted involving 18 experts in the use of fluorescence imaging during lymphatic surgery, all asked to vote on 49 statements on patient preparation and contraindications (n = 7 statements), indocyanine green dosing and administration (n = 10), fluorescence imaging uses and potential advantages (n = 16), and potential disadvantages and training needs (n = 16). Results: Consensus ultimately was reached on 40/49 statements, including consistent consensus regarding the value of fluorescence imaging with indocyanine green in almost all facets of lymphedema patient management, including early detection, assessing disease extent, preoperative work-up, surgical planning, intraoperative guidance, monitoring short- and longer-term outcomes, quality control, and resident training. All experts felt it was very safe, while 94% felt it should be part of routine care and that indocyanine green was superior to colored dyes and ultrasound. Nonetheless, there also was consensus that limited high-quality evidence remains a barrier to its widespread use and that patients should still be provided with specific information and asked to sign specific consent for both fluorescence imaging and indocyanine green. Conclusion: Fluorescence imaging with or without indocyanine green appears to have several roles in lymphedema prevention, diagnosis, assessment, and treatment.
UR - http://www.scopus.com/inward/record.url?scp=85142940340&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2022.08.026
DO - 10.1016/j.surg.2022.08.026
M3 - Article
C2 - 36427924
AN - SCOPUS:85142940340
SN - 0039-6060
VL - 172
SP - S14-S20
JO - Surgery
JF - Surgery
IS - 6 Supplement
ER -