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Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases

Abstract

Background

Indo-Cyanine Green Fluorescence is an emerging technology with more frequent use in laparoscopic and robotic surgery. It relies on near-infrared (NIR) fluorescence to demonstrate tissue perfusion with demarcation of tissue planes and vascular pedicles. The aim of the study is to evaluate the role of this technology in laparoscopic adrenalectomy (LA).

Methods

55 patients underwent laparoscopic adrenalectomy using NIR Fluorescence enabled laparoscope. All cases received a standard initial dose of 5-mg dye to aid tissue visualization. Surgery proceeded with “fluorescence mode” demonstrating real-time NIR images superimposed on standard white-light imaging. The timing, number of doses were dictated by the operating surgeon, which were recorded and correlated with intra-operative fluorescence visualization.

Results

54 patients underwent successful LA, with one conversion in a case of large pheochromocytoma due to difficult hemostasis. The lag between ICG administration and visualization of adrenal fluorescence varied between 30 and 75 s. The total duration of adrenal parenchymal fluorescence after a single dose did not exceed 15 min in our series. Average total administered dose was 14.4 mg. We suffered no mortality. There were no adverse effects due to the dye. 5 patients suffered Grade I complications, with one patient suffering Grade II and IV complication each, as per Clavien–Dindo Classification. Final histopathology demonstrated pheochromocytoma, adrenocortical adenoma, adrenocortical carcinoma, cushing’s adenoma, aldosteronoma, and myelolipoma.

Conclusion

We describe our initial positive experience with ICG fluorescence in LA, with a detailed description of dye administration in our study. The technology offers real-time differentiation of tissues and identification of vascular structures, providing immediate guidance during surgery. Further evaluation of its role in adrenocortical malignancy is warranted. NIR fluorescence is a safe, useful addition in laparoscopic adrenalectomy which will undergo further refinement over time.

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Correspondence to Eham Arora.

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Disclosures

The authors would like to state that this manuscript is being submitted as an accompaniment to podium presentation at SAGES 2018, held at Seattle, USA titled “Use of IndoCyanine Green (ICG) Fluorescence in Laparoscopic Adrenalectomy.” Program number: S135 (Solid Organ Session). Eham Arora, Ajay Bhandarwar, Amol Wagh, Saurabh Gandhi, Chintan Patel, Shubham Gupta, Gagandeep Talwar, Jasmine Agarwal, Jai Rathore, Soumya Chatnalkar have no conflict of interest or financial ties to disclose.

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Arora, E., Bhandarwar, A., Wagh, A. et al. Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases. Surg Endosc 32, 4649–4657 (2018). https://doi.org/10.1007/s00464-018-6309-7

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Keywords

  • Laparoscopic adrenalectomy
  • Adrenalectomy
  • Indo-cyanine green
  • Fluorescence angiography
  • Near-infrared imaging