All of the tracers were sub-mucosally injected in four quadrants of the cervix at 0, 3, 6, and 9 o’clock. The cervical injection was approximately 5 mm in all cases, as described previously [25 (link)–27 (link)]. On the day before the operation, 2.0 ml of fluid containing 110 MBq 99m-Technetium (99mTc)-labeled tin colloids was injected into the patient’s cervix. Lymphoscintigraphy was performed within 6 h, and hot spots, indicating SLNs, were identified. On the day of the operation, 5 ml of indigo carmine (IDC) (2 mg/ml) and/or indocyanine green (ICG) (50 µg/ml) was injected into the cervix at the start of surgery. The same quantity of IDC and/or ICG was also injected into the uterine fundus upon reaching the intra-abdominal cavity. The SLN was detected at 40 min after injection of IDC or ICG. Radioactive lymph nodes were located using a gamma-probe (Navigator GPS; RMD). IDC-stained lymph nodes were detected by direct inspection. ICG fluorescence-positive lymph nodes were detected using a color fluorescence camera (Hyper Wye Medical System, Mizuho Co., for laparotomy; Camera Control Unit JC300, MC Medical Co., for laparoscopy). After the SLN biopsy, the area of pelvic lymph node was surveyed by direct observation, and with a color fluorescence camera or a gamma-probe to confirm that no radioactive tissue remained. A combination of 99mTc and IDC was used in the early phase and a combination of the three tracers was used in the late phase.
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