Near-Infrared Fluorescence Imaging with Intraoperative Administration of Indocyanine Green for Robotic Partial Nephrectomy

Abstract

Near-infrared fluorescence (NIRF) imaging with intraoperative administration of indocyanine green (ICG) is a technology with emerging applications in urologic surgery. ICG is a water-soluble dye that fluoresces bright green when viewed under near-infrared light (700-1000 nm). This technology has been applied to robotic partial nephrectomy, first to potentially allow for the differentiation of renal tumor from normal parenchyma. In this application, it has been hypothesized that normal kidney tissue fluoresces green, while the tumor commonly remains hypofluorescent, thereby aiding tumor excision. Secondly, NIRF imaging with ICG has been employed to facilitate selective arterial clamping during robotic partial nephrectomy, allowing for a regional perfusion deficit in the kidney to be readily identified and therefore targeted at a given tumor. Recent studies have shown the associated decrease in global ischemia to minimize resultant loss of renal function at certain time endpoints. This review presents the most recent studies and evidence on the intraoperative administration of indocyanine green for robotic partial nephrectomy.

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

“…However, a separate study from the same group found that NIR with indocyanine green was unreliable in identifying malignancy, as correlated with final histology [46].…”

The future of partial nephrectomy

“…There have been many techniques described to induce renal cooling including peri-renal ice slush, cold saline surface irrigation, endoscopic retrograde renal cooling, and trans-arterial renal hypothermia, with varying degrees of success. Kaouk et al, described intracorporeal cooling which placement of the kidney inside an Endocatch II bag filled with ice slush to achieve a temperature of [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] degrees [23]. A recent method that avoids the use of a cumbersome bag, and is not limited to the retroperitoneal approach was by placing ice on the psoas muscle and then over the renal parenchyma, with a laparoscopic sponge placed on the small bowel to prevent bowel cooling ( [23].…”

Robotic Radical Partial Nephrectomy: Keep Pushing the Boundaries

“…Recently, the use of a near-infrared fluorescence (NIRF) imaging system using indocyanine green (ICG) dye has been described during robotic partial nephrectomy as an adjunctive means of identifying renal vasculature and tumour clearance. ICG is a water-soluble dye that fluoresces bright green when viewed under near-infrared light (700-1000 nm) [4]. This technology has been applied to robotic partial nephrectomy, to look for the differentiation of renal tumor from normal parenchyma [4].…”

“…ICG is a water-soluble dye that fluoresces bright green when viewed under near-infrared light (700-1000 nm) [4]. This technology has been applied to robotic partial nephrectomy, to look for the differentiation of renal tumor from normal parenchyma [4]. In this application, it has been hypothesized that normal kidney tissue fluoresces green, while the tumor commonly remains hypofluorescent, thereby aiding tumor excision [4].…”

“…This technology has been applied to robotic partial nephrectomy, to look for the differentiation of renal tumor from normal parenchyma [4]. In this application, it has been hypothesized that normal kidney tissue fluoresces green, while the tumor commonly remains hypofluorescent, thereby aiding tumor excision [4]. Secondly, NIRF imaging with ICG has been employed to facilitate selective arterial clamping during robotic partial nephrectomy, allowing for a regional perfusion deficit in the kidney to be readily identified and therefore targeted at a given tumor [4].…”