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Gynecology

Hysteroscopy in the diagnosis and therapy of intrauterine disorders is now standard procedure in clinics and, to an increasing extent, in outpatient settings and private practices. Thanks to the miniaturization of the hysteroscopes, many procedures can now be performed with a minimum of trauma and without general anesthesia away from the OR. KARL STORZ has played a major role in this development and offers a number of "office" hysteroscopes with very small diameters.

Along with a product line for standard gynecological procedures using hysteroscopic and/or laparoscopic techniques, the KARL STORZ portfolio also includes endoscopes and specialized instruments for reproductive surgery and fetoscopy. Various amnioscopes for obstetrics or ductoscopes for mammary ductoscopy, with a diameter of approx. 0.8 mm, round off the range of products for gynecology.

Many gynecological procedures today can be performed using laparoscopic surgical techniques. Our product range is constantly being expanded not only to include morcellation systems or uterine manipulators for standard procedures such as myoma enucleation or supracervical hysterectomies (LASH) but also to offer instruments for niches such as the creation of laparoscopic-assisted neovagina.

Highlights

Visualizing the lymphatic system with ICG in tumor surgery*

The KARL STORZ Near Infrared (NIR/ICG) system and the marker indocyanine green (ICG) enables non-radioactive visualization of the entire lymphatic system surrounding a tumor in real time, e.g., in a laparoscopic manner.

The system offers the following advantages:

  • Non-radioactive lymph node detection method
  • Multidisciplinary use
  • Xenon-based technology (no laser safety measures necessary)
  • Intuitive switchover between standard white light and fluorescence mode via footswitch
  • Physicians describe their surgical experience with the system as follows: The NIR/ICG system allows the reduction of radical lymphadenectomy and, at the same time, visual control makes the en-bloc resection of lymph nodes easier.


*The intradermal administration of indocyanine green for (S)LN has already been approved in Italy (breast cancer), Japan and Russia. Please inform yourself in advance about the potential for the off-label use of ICG in your hospital / country.

Laparoscopic visualization of the lymphatic system in gynecology with the NIR/ICG system

In gynecology, the degree of tumor involvement in the sentinel lymph node (SLN) is of great importance as it provides medical information about the tumor stage and is thus one of the main prognostic factors. In breast cancer surgery, SLN detection with the radioactive tracer 99mTc is the gold standard. In other areas of gynecological tumor surgery, its benefits in comparison to elective lymph node dissection is the subject of discussion. As a new, non-radioactive imaging technique, NIR imaging with ICG can provide a useful contribution to this field.1 SLN mapping of endometrial carcinoma yielded the following results (radioactive tracer 99mTc vs. ICG):

 

Radioactive Tracer 99mTc

ICG

Total SLN
detection rate

Bilateral SLN

Total SLN detection rate

Bilateral SLN
Study 12  83 %  61 %  95,5 %  95,5 %

 

1 Papadia et al., Doctor-to-Doctor Manual ENDO-PRESS®, ICG-enhanced Fluorescence-guided SLN Mapping in Gynecological Malignancies (ISBN 978-3-89756-932-4)

2 Imboden et al., Surg. Oncol. 2015

VITOM® II ICG – Use for vulvar carcinoma

The VITOM® II ICG from KARL STORZ provides an optimal solution for the sentinel lymph node mapping in the case of vulvar carcinoma. VITOM® II ICG is an exoscope that combines the benefits of both endoscopy and microscopy. It is used with the same camera system that is employed in endoscopy (IMAGE1 S NIR system).

  • NIR visualization with the VITOM® II ICG – in addition to technetium and blue dye – offers the surgeon a straightforward method for the detection and selective removal of sentinel lymph nodes (SLN) in the case of vulvar carcinoma
  • Possibility for the integration of an exoscope by means of a holding arm into the gynecologist’s operating field

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