Indocyanine Green (ICG) Lymphography, also known as near-infrared lymphography, is an advanced imaging technique used to visualise the lymphatic system. This procedure employs a special dye called indocyanine green, which is injected into the tissue near the area being examined. When exposed to near-infrared light, this dye fluoresces, allowing healthcare providers to see the lymphatic vessels and nodes in real-time.

Other Terms for Indocyanine Green (ICG) Lymphography

Indocyanine Green (ICG) Lymphography may be referred to as various terms in different clinical settings and countries. It may be known as ICG lymphatic mapping, fluorescent lymphography or near-infrared fluorescence lymphography.

Why is Indocyanine Green (ICG) Lymphography Performed?

Indocyanine Green (ICG) Lymphography is performed to assess the condition of the lymphatic system in patients with various medical concerns. This technique, performed by a highly-skilled multidisciplinary team of doctors and therapists working with Dr Quan Ngo at the Australian Lymphoedema Education, Research, and Treatment centre (ALERT) at Macquarie University Hospital in Sydney, offers valuable insights into the structure and function of the lymphatic vessels and nodes. 

Evaluation of Lymphoedema

One of the primary reasons for performing Indocyanine Green (ICG) Lymphography is to evaluate lymphoedema. Lymphoedema is a chronic condition characterised by swelling, often in the arms or legs, due to impaired lymphatic drainage. By visualising the lymphatic vessels and nodes, this procedure helps diagnose and assess the severity of lymphoedema.

Identification of Lymphatic Obstructions

Indocyanine Green (ICG) Lymphography aids in identifying any obstructions or blockages within the lymphatic system. These obstructions may hinder the normal flow of lymph fluid, contributing to conditions like lymphoedema. By pinpointing these obstructions, Dr Ngo can develop targeted treatment plans to alleviate symptoms and improve lymphatic function.

Assessment of Lymphatic Flow Patterns

Another crucial aspect of Indocyanine Green (ICG) Lymphography is the evaluation of lymphatic flow patterns. Abnormal flow patterns can indicate underlying issues within the lymphatic system, such as valve dysfunction or vessel damage. Understanding these patterns helps Dr Ngo to tailor treatment strategies to address specific concerns and optimise lymphatic function.

Preoperative Planning for Lymphatic Surgeries

For patients undergoing lymphatic surgeries, such as lymph node transfer or lymphovenous anastomosis (LVA), Indocyanine Green (ICG) Lymphography plays a vital role in preoperative planning. By providing detailed imaging of the lymphatic anatomy, this procedure assists Specialist Plastic Surgeons like Dr Quan Ngo in identifying optimal surgical targets, including donor sites for lymph node transfer and suitable vessels for anastomosis.

Guidance during Lymphatic Procedures

During lymphatic surgeries, real-time guidance from Indocyanine Green (ICG) Lymphography enhances surgical precision and accuracy. Dr Ngo can use the fluorescence of the dye to navigate the lymphatic system, ensuring meticulous dissection and optimal placement of surgical grafts or anastomoses. This intraoperative guidance contributes to better surgical outcomes and improved patient recovery.

Determining Patient Suitability for Indocyanine Green (ICG) Lymphography

Before undergoing Indocyanine Green (ICG) Lymphography, patients undergo a thorough evaluation to determine their suitability for the procedure. Led by Dr Quan Ngo and the multidisciplinary team at ALERT, this assessment ensures that patients receive safe and effective care tailored to their individual needs. Determination of patient suitability for Indocyanine Green (ICG) Lymphography is comprehensive and multifactorial, including:

Medical History Review

The first step in assessing patient suitability is a comprehensive review of the patient's medical history. This includes information about any underlying medical conditions, previous surgeries, allergies, and medications. Certain medical conditions or medications may affect the safety or interpretation of the procedure, and it is essential for Dr Quan Ngo to be aware of any relevant details.

Symptom Assessment

Patients undergoing evaluation for Indocyanine Green (ICG) Lymphography are typically experiencing symptoms related to lymphatic disorders, such as swelling, discomfort, or restricted mobility. The severity and duration of these symptoms are evaluated to determine the potential benefits of the procedure. Additionally, patients may be asked about any specific concerns or goals they have regarding their lymphatic health.

Diagnostic Indications

The decision to proceed with Indocyanine Green (ICG) Lymphography is guided by specific diagnostic indications. This may include suspected lymphoedema, evaluation for lymphatic abnormalities, or preoperative planning for lymphatic surgeries. The healthcare team, led by Dr. Quan Ngo, carefully considers the clinical indications for the procedure and whether it will provide valuable diagnostic information to customise patient care.

Risks and Benefits Discussion

Patients are provided with detailed information about the risks and benefits of Indocyanine Green (ICG) Lymphography. This includes potential risks such as allergic reactions to the dye, temporary skin discoloration, or rare complications. The healthcare team, including Dr. Quan Ngo, ensures that patients have a clear understanding of what to expect and can make informed decisions about proceeding with the procedure.

Patient Preferences and Comfort

Patient preferences and comfort are important factors in determining suitability for Indocyanine Green (ICG) Lymphography. Patients are encouraged to discuss any concerns or preferences they have regarding the procedure, and their comfort level with the process is taken into consideration. The healthcare team and Dr. Quan Ngo strive to create a supportive and patient-centred environment throughout the evaluation process.

Integration of Indocyanine Green (ICG) Lymphography with Surgical Procedures and Lymphoedema Surgery

The integration of Indocyanine Green (ICG) Lymphography with surgical procedures, particularly those aimed at managing lymphoedema, represents a significant advancement in precision medicine. This approach combines imaging technology at multiple stages, with surgical expertise to optimise treatment outcomes.

Preoperative Planning

Before undergoing lymphoedema surgery, patients may undergo Indocyanine Green (ICG) Lymphography as part of the preoperative planning process. This imaging technique provides detailed visualisation of the lymphatic system, allowing specialist plastic surgeons like Dr. Quan Ngo to assess lymphatic anatomy and identify optimal surgical targets. By mapping lymphatic channels and assessing flow patterns, ICG lymphography helps guide surgical decision-making and ensures a tailored approach to treatment.

Surgical Guidance

During lymphoedema surgery, real-time guidance from Indocyanine Green (ICG) Lymphography enhances surgical precision and accuracy. Dr Ngo utilises the fluorescence of the dye to navigate the lymphatic system, confirming the location of lymphatic vessels and nodes. This intraoperative guidance ensures meticulous dissection and placement of surgical grafts or anastomoses, minimising the risk of complications and optimising surgical outcomes.

Targeted Interventions

Indocyanine Green (ICG) Lymphography enables Dr Quan Ngo to perform targeted interventions based on the specific findings of the imaging study. For example, if lymphatic obstructions are identified, Dr Ngo can focus on addressing these blockages during surgery. Similarly, if abnormal flow patterns are detected, surgical techniques can be tailored to restore normal lymphatic function and improve fluid drainage.

Assessment of Surgical Success

Following lymphoedema surgery, Indocyanine Green (ICG) Lymphography may be used to assess the success of the procedure. By repeating the imaging study postoperatively, Dr Ngo and his surgical team can evaluate the efficacy of surgical interventions and confirm improvements in lymphatic function. This objective assessment helps guide postoperative management and ensures that patients achieve the best possible outcomes.

Patient-Centred Care

The integration of Indocyanine Green (ICG) Lymphography with surgical procedures exemplifies a patient-centred approach to care. By combining advanced imaging technology with surgical expertise, patients receive personalised treatment that addresses their unique needs and concerns. Dr Quan Ngo and the healthcare team collaborate closely with patients throughout the surgical journey, ensuring that they are informed, supported, and empowered to achieve optimal outcomes.

In summary, the integration of Indocyanine Green (ICG) Lymphography with surgical procedures and lymphoedema surgery represents a significant advancement in the management of lymphatic disorders. This approach combines state-of-the-art imaging technology with surgical expertise to optimise treatment outcomes and best possible patient care.