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Preoperative ultrasound- guided localization of cystic lesions in the knee using indigo carmine injection Hee-Jin Park 1, Sung-Moon Lee 2, Jung-Ah Choi.

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Presentation on theme: "Preoperative ultrasound- guided localization of cystic lesions in the knee using indigo carmine injection Hee-Jin Park 1, Sung-Moon Lee 2, Jung-Ah Choi."— Presentation transcript:

1 Preoperative ultrasound- guided localization of cystic lesions in the knee using indigo carmine injection Hee-Jin Park 1, Sung-Moon Lee 2, Jung-Ah Choi 3 Kwandong University Myongji Hospital 1 Keimyoung University Dongsan Hospital 2 SNUBH 3

2 Introduction For preoperative localization of benign cystic lesions around the knee joint, such as popliteal cysts or meniscal cysts, indigo carmine staining can be performed under ultrasound guidance. Indigo carmine is injected to mark the cystic lesion and surgeons confirm the lesion by the blue color arthroscopically or surgically.

3 Purpose To evaluate the feasibility and effectiveness of preoperative ultrasound-guided localization of cystic lesions in the knee using indigo carmine injection for precise surgical localization.

4 Materials and Methods Between October 2004 and April 2009, 23 patients underwent percutaneous indigo carmine staining under ultrasound guidance. Twenty three cases (fifteen men, eight women, mean age 42 years)

5 Materials and Methods meniscal cysts(12) popliteal cysts(7) ganglion cysts(4) The preoperative diagnoses of the lesions were made on preoperative MRI in all patients.

6 Materials and Methods The ultrasound scanner used was HDI- 5000(Advanced Technology Laboratories, Bothwell, WA USA) linear array transducers(with a central frequency of 12-17 MHz).

7 Background The treatment of meniscal cysts include 1) isolated cyst excision 2) cyst excision combined with total menisectomy more recently 3) arthroscopic surgery combined with either intraarticular cyst decompression or open cystectomy.

8 The surgical literature now strongly supports the view that treatment of meniscal cysts should include decompression of the cyst as well as appropriate arthroscopic treatment of associated meniscal abnormalities AJR 2001;177:409-413

9 Dilemma Meniscal cysts are occasionally overlooked at the time of arthroscopy The surgical approach to the posterior horn of the medial meniscus is difficult and as a result, small meniscal cysts located along the posterior aspect of the medial meniscus may be overlooked at surgery So correct localization of the cystic lesion and confirmation of the decompression is very important for surgeon. J bone Joint Surg Br 1993;75-B:293-298

10 Indigo carmine sodium indigotindisulfonate - safe, biologically inert substance - commonly used during cystoscopy when evaluating for lower urinary tract safety after gynecologic surgery Int Urogynecol J 2005;16: 418-419

11 Adverse reactions Some adverse reactions(hypotension and bradycardia) to indigo carmine have been reported. But intravenous administration only Urology 1994;44:271-272

12 Technique The skin was prepared with povidone-iodine solution and sterilely draped. A 1% lidocaine solution was used for local anesthesia. Approximately 0.2-3ml of indigo carmine(sodium indigotindisulfonate, USP, inject, 0.8%, United Korea) was injected 22-gauge spinal needle All injections were performed using a freehand technique with the patient in supine or prone position

13 After localization the patients were transfered to the operating room immediately and surgical procedures were performed. The lesions were removed by arthroscopy (n= 20) or open surgery (n=3). Surgical records, including arthroscopic images, were reviewed.

14 Results Staining with indigo carmine dye was successfully achieved in all patients. Twenty cases were confirmed during arthroscopy and three cases were confirmed during excisional surgery.

15 Results No significant complication(massive bleeding, large hematoma) occurred during the procedure. No anaphylactic reaction. Four patients said they felt pain during aspiration before indigo carmine injection.

16 Results Dye droplet leakages were noted in two patients and gross leakage were noted in three patients on arthroscopy

17 56-year-old woman with meniscal cyst

18 60-year-old woman with popliteal cyst

19 34-year-old man with spinoglenoid ganglion of shoulder.

20 Conclusion Indigo carmine staining allowed quick identification of the cystic lesion during arthroscopy by the surgeon. The staining reassured the surgeons that they had decompressed the correct lesion.

21 Conclusion Ultrasound-guided Indigo carmine injection is an accurate technique for localizing benign cystic lesions around the knee and can be easily and safely performed. The technique may provide a more compatible and clear visual field for the surgeon.

22 Thank you for your attention Thank you for your attention


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