Near-infrared Fluorescence Imaging: Emerging Applications in Robotic Upper Urinary Tract Surgery

Applications of indocyanine green in robotic urology

“…The combination of fluorescent intraoperative imaging and robotic surgery is a logical progression in peri-operative tissue visualisation. The fusion of minimally invasive surgery and localised imaging has been described in the identification of sentinel lymph nodes and renal cancer [18, 19], super selective arterial clamping for nephron sparing [20], and precise dissection of the prostatic neurovascular bundle [21]. …”

First-in-human evaluation of a hybrid modality that allows combined radio- and (near-infrared) fluorescence tracing during surgery

“…For future purposes, one may also want to apply the fluorescence tracing technology during ICG perfusion measurements (e.g. kidney ischemia [17]), ICG-based tumor tracing (e.g. exploring the liver for the presence of colorectal metastasis [18]), or even in combination with tumor receptor targeting tracers functionalized with a fluorescence dye like ICG [19] or alternative NIR dyes such as Cy7 (λ ex : 750 nm; λ em : 773 nm; Luminoprobe GmbH, Hannover, Germany), CW800 (λ ex : 778 nm; λ em : 794 nm; LI-COR Biosciences, Lincoln, NE, USA), or ZW800 (λ ex : 772 nm; λ em : 788 nm [20]).…”

Advances in fluorescent-image guided surgery

“…For example, approximately 1% of the population is hypersensitive to iodine and cannot be given ICG (139). Another contraindication is elevated liver function tests (113). Alternative imaging molecules must be sought for these patients.…”

“…In robotic nephrectomies where warm ischemia is induced by renal artery clamping, using fluorescent visualization as a visual aid helped reduce the overall time the kidney was ischemic (111). As seen with other surgeries, ICG alerted surgeons to abnormal vascular anatomy, helping them avoid unintended injuries that would be otherwise difficult to predict (112,113). This technology could help surgeons spare larger portions of the kidney in partial nephrectomy and reduce postoperative complications, blood loss, and metastasis (113,114).…”

“…As seen with other surgeries, ICG alerted surgeons to abnormal vascular anatomy, helping them avoid unintended injuries that would be otherwise difficult to predict (112,113). This technology could help surgeons spare larger portions of the kidney in partial nephrectomy and reduce postoperative complications, blood loss, and metastasis (113,114). Similarly, ICG was used in robotic partial adrenalectomy to differentiate between adrenal mass and normal parenchyma, helping to spare as much of the adrenal gland as possible while completely excising the tumor (115,116).…”