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 (Osler or Fluobeam 800), and for the evaluation of the patent lymphatic ducts and patency preoperatively of lymphovenous anastomosis intraoperatively at operation room (Spy Elite).

Osler 2000 (Chang Gung Medical Company, Inc.)

Indocyanine Green (ICG) Lymphography - Osler 2000 (Chang Gung Medical Company, Inc.)

Indocyanine Green (ICG) Lymphography - Osler 2000

  • “Chang Gung” Fluorescence Imaging System Osler 2000 is a fluorescent image photography device, so that the surgeon can shoot, review, store high-quality fluorescent image device.
  • “Chang Gung” Fluorescence Imaging System Osler 2000 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.

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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