Background: Landmark artery identi cation in the neurovascular bundle (NVB) is important for nervesparing in radical prostatectomy. We aimed to investigate intraoperative angiography using indocyanine green and near-infrared uorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to identify the NVB, visualise vascularisation and haemostasis, and preserve erectile function.Methods: Retrospective, unicentric study of 91 consecutive localised prostate cancer RARP patients (stage T1/T2, prostate speci c antigen <10 ng/ml) who underwent ICG-NIRF angiography in France (2016)(2017)(2018)(2019)(2020)(2021). When ready to dissect the NVB, the anaesthesiologist intravenously injected ICG (3 ml); the surgeon used alternating standard light or uorescence to optimise NVB visualisation and facilitate microdissection. Primary outcomes: safety and feasibility of ICG-NIRF. Secondary outcomes: functional erectile dysfunction (Sexual Health Inventory for Men questionnaire) over 9 months, proportion of bilateral NVBs identi ed, ICG-related complications. Standard descriptive statistics were used; t-test determined the signi cance of changes in SHIM scores versus baseline.Results: Ninety-one patients received intraoperative angiography. The NVB was identi ed in all cases, without di culties. No ICG-related complications or allergies were observed. There was no signi cant difference in the SHIM score at 9 months compared with baseline (p=0.331), and erectile dysfunction returned to baseline levels in almost all patients.Conclusions: Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identi cation of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should con rm preliminary results.
Background: Landmark artery identification in the neurovascular bundle (NVB) is important for nerve-sparing in radical prostatectomy. We aimed to investigate intraoperative angiography using indocyanine green and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to identify the NVB, visualise vascularisation and haemostasis, and preserve erectile function.Methods: Retrospective, unicentric study of 91 consecutive localised prostate cancer RARP patients (stage T1/T2, prostate specific antigen <10 ng/ml) who underwent ICG-NIRF angiography in France (2016–2021). When ready to dissect the NVB, the anaesthesiologist intravenously injected ICG (3 ml); the surgeon used alternating standard light or fluorescence to optimise NVB visualisation and facilitate microdissection. Primary outcomes: safety and feasibility of ICG-NIRF. Secondary outcomes: functional erectile dysfunction (Sexual Health Inventory for Men questionnaire) over 9 months, proportion of bilateral NVBs identified, ICG-related complications. Standard descriptive statistics were used; t-test determined the significance of changes in SHIM scores versus baseline. Results: Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed. There was no significant difference in the SHIM score at 9 months compared with baseline (p=0.331), and erectile dysfunction returned to baseline levels in almost all patients.Conclusions: Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results.
Surgeons had favorable attitudes towards its functional features and expressed likelihood to use the device if it were available. Users utilized different view types based on different task needs. Poorer image quality of the prototype MRFL was associated with longer task times.
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