1231 EVALUATION OF NEAR INFRARED FLUORESCENCE REAL TIME IMAGING WITH INDOCYANINE GREEN DURING ROBOTIC PARTIAL NEPHRECTOMY: INITIAL EXPERIENCE IN 50 CONSECUTIVE PATIENTS

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You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease I1 Apr 20121231 EVALUATION OF NEAR INFRARED FLUORESCENCE REAL TIME IMAGING WITH INDOCYANINE GREEN DURING ROBOTIC PARTIAL NEPHRECTOMY: INITIAL EXPERIENCE IN 50 CONSECUTIVE PATIENTS Ted Manny, Spencer Krane, Srinivas Rajamahanty, Timil Patel, Michael Olympio, and Ashok Hemal Ted MannyTed Manny Winston Salem, NC More articles by this author , Spencer KraneSpencer Krane Winston Salem, NC More articles by this author , Srinivas RajamahantySrinivas Rajamahanty Winston Salem, NC More articles by this author , Timil PatelTimil Patel Winston Salem, NC More articles by this author , Michael OlympioMichael Olympio Winston Salem, NC More articles by this author , and Ashok HemalAshok Hemal Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Indocyanine green (ICG) is a non-toxic dye which enables near infrared fluorescence (NIRF) imaging of renal parenchyma and masses in real time when visualized with an ICG-capable daVinci Si robot. Potential advantages to this technology include enhanced visualization of the renal vasculature and increased visual contrast between normal parenchyma and renal masses. We sought to evaluate the technical feasibility, safety, utility, and perioperative outcomes of ICG during robotic assisted partial nephrectomy (RAPN). METHODS Fifty unselected consecutive patients undergoing RAPN were given 2 -3 mL intravenous ICG dye before hilar clamping (warm ischemia) or resection (no ischemia). In 4 cases selective arterial clamping was done prior to injection of ICG. Tumor resection and renorraphy were then performed toggling between the standard white light and NIRF green light modes. RESULTS A single dose of ICG allowed transient differential visualization of the renal artery and vein followed by parenchymal fluorescence in all cases. This was useful in confirming regional ischemia in cases of segmental artery clamping. Nephrometry of renal masses was low (6-7) in 66%, moderate (8-10) in 26%, and high (>10) in 8% of patients. All masses were hypofluorescent relative to surrounding parenchyma [Fig 1]. Twenty percent of masses were benign, comprising 30% angiomyolipoma, 30% oncocytoma, and 40% cysts. Angiomyolipoma and especially cysts were the most hypofluorescent. Eighty percent of masses were malignant comprising 70% clear cell, 20% papillary, and 10% chromophobe renal cell carcioma. We found ICG to be of no help in the resection of predominantly endophytic lesions or in cases of zero ischemia. Three positive margins (6%) occurred. There were no adverse reactions attributable to ICG. CONCLUSIONS ICG-NIRF is safe and feasible for patients undergoing RAPN and allows for differential visualization of a variety of benign and malignant lesions. We feel ICG is most useful in cases of segmental arterial clamping, resection of cystic lesions and predominantly exophytic lesions. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByHemal A and Golijanin D (2018) Does Infrared Imaging Improve Partial Nephrectomy for Renal Cell Carcinoma?Journal of Urology, VOL. 188, NO. 4, (1078-1080), Online publication date: 1-Oct-2012. Volume 187Issue 4SApril 2012Page: e498 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ted Manny Winston Salem, NC More articles by this author Spencer Krane Winston Salem, NC More articles by this author Srinivas Rajamahanty Winston Salem, NC More articles by this author Timil Patel Winston Salem, NC More articles by this author Michael Olympio Winston Salem, NC More articles by this author Ashok Hemal Winston Salem, NC More articles by this author Expand All