Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases
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...
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| Veröffentlicht in: | Surgical endoscopy 2018-11, Vol.32 (11), p.4649-4657 |
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| creator | Arora, Eham Bhandarwar, Ajay Wagh, Amol Gandhi, Saurabh Patel, Chintan Gupta, Shubham Talwar, Gagandeep Agarwal, Jasmine Rathore, Jai Chatnalkar, Soumya |
| description | 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. |
| doi_str_mv | 10.1007/s00464-018-6309-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2059552492</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2058844616</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-c87ad186ad938123b550bc2befe58f30e9cfa950000a27f9359915ce05687ce03</originalsourceid><addsrcrecordid>eNp1kdFLHDEQxkOp6FX9A_pSAn2xD9FJstlN-iZHawVBEH0OueysrOxttsmt5f77znm2hYJPw8z85gtfPsY-SjiXAM1FAajqSoC0otbgRPOOLWSllVBK2vdsAU6DUI2rjtiHUp6AcCfNITtSzlUaarNg6S4NyFPH-7FNIm7D2I_IHzPiyM-ul1dfeDfMKWOJOEYkig9hCjmVmKY-8tBmHMOAcZPW26888IwbWk406J-Ruucef-3kjeHLULCcsIMuDAVPX-sxe_j-7X75Q9zcXl0vL29E1I3aiGib0Epbh9ZpK5VeGQOrqFbYobGdBnSxC86QIwiq6Zw2jpxFBFPbhoo-Zmd73SmnnzOWjV_35GEYwohpLl6BccaoyilCP_-HPqU5k6sXytqqqmVNlNxTkfyVjJ2fcr8Oeesl-F0afp-GpzT8Lg3f0M2nV-V5tcb278Wf7ydA7YFCq_ER87-n31b9DVuxk94</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2058844616</pqid></control><display><type>article</type><title>Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases</title><source>SpringerLink Journals - AutoHoldings</source><creator>Arora, Eham ; Bhandarwar, Ajay ; Wagh, Amol ; Gandhi, Saurabh ; Patel, Chintan ; Gupta, Shubham ; Talwar, Gagandeep ; Agarwal, Jasmine ; Rathore, Jai ; Chatnalkar, Soumya</creator><creatorcontrib>Arora, Eham ; Bhandarwar, Ajay ; Wagh, Amol ; Gandhi, Saurabh ; Patel, Chintan ; Gupta, Shubham ; Talwar, Gagandeep ; Agarwal, Jasmine ; Rathore, Jai ; Chatnalkar, Soumya</creatorcontrib><description>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.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6309-7</identifier><identifier>PMID: 29943065</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2018 SAGES Oral ; Abdominal Surgery ; Gastroenterology ; Gynecology ; Hepatology ; Laparoscopy ; Medicine ; Medicine & Public Health ; Neuroendocrine tumors ; Proctology ; Robotic surgery ; Surgery ; Tumors ; Visualization</subject><ispartof>Surgical endoscopy, 2018-11, Vol.32 (11), p.4649-4657</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Surgical Endoscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-c87ad186ad938123b550bc2befe58f30e9cfa950000a27f9359915ce05687ce03</citedby><cites>FETCH-LOGICAL-c372t-c87ad186ad938123b550bc2befe58f30e9cfa950000a27f9359915ce05687ce03</cites><orcidid>0000-0002-5120-3356</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6309-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6309-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29943065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arora, Eham</creatorcontrib><creatorcontrib>Bhandarwar, Ajay</creatorcontrib><creatorcontrib>Wagh, Amol</creatorcontrib><creatorcontrib>Gandhi, Saurabh</creatorcontrib><creatorcontrib>Patel, Chintan</creatorcontrib><creatorcontrib>Gupta, Shubham</creatorcontrib><creatorcontrib>Talwar, Gagandeep</creatorcontrib><creatorcontrib>Agarwal, Jasmine</creatorcontrib><creatorcontrib>Rathore, Jai</creatorcontrib><creatorcontrib>Chatnalkar, Soumya</creatorcontrib><title>Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>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.</description><subject>2018 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroendocrine tumors</subject><subject>Proctology</subject><subject>Robotic surgery</subject><subject>Surgery</subject><subject>Tumors</subject><subject>Visualization</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kdFLHDEQxkOp6FX9A_pSAn2xD9FJstlN-iZHawVBEH0OueysrOxttsmt5f77znm2hYJPw8z85gtfPsY-SjiXAM1FAajqSoC0otbgRPOOLWSllVBK2vdsAU6DUI2rjtiHUp6AcCfNITtSzlUaarNg6S4NyFPH-7FNIm7D2I_IHzPiyM-ul1dfeDfMKWOJOEYkig9hCjmVmKY-8tBmHMOAcZPW26888IwbWk406J-Ruucef-3kjeHLULCcsIMuDAVPX-sxe_j-7X75Q9zcXl0vL29E1I3aiGib0Epbh9ZpK5VeGQOrqFbYobGdBnSxC86QIwiq6Zw2jpxFBFPbhoo-Zmd73SmnnzOWjV_35GEYwohpLl6BccaoyilCP_-HPqU5k6sXytqqqmVNlNxTkfyVjJ2fcr8Oeesl-F0afp-GpzT8Lg3f0M2nV-V5tcb278Wf7ydA7YFCq_ER87-n31b9DVuxk94</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Arora, Eham</creator><creator>Bhandarwar, Ajay</creator><creator>Wagh, Amol</creator><creator>Gandhi, Saurabh</creator><creator>Patel, Chintan</creator><creator>Gupta, Shubham</creator><creator>Talwar, Gagandeep</creator><creator>Agarwal, Jasmine</creator><creator>Rathore, Jai</creator><creator>Chatnalkar, Soumya</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5120-3356</orcidid></search><sort><creationdate>20181101</creationdate><title>Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases</title><author>Arora, Eham ; Bhandarwar, Ajay ; Wagh, Amol ; Gandhi, Saurabh ; Patel, Chintan ; Gupta, Shubham ; Talwar, Gagandeep ; Agarwal, Jasmine ; Rathore, Jai ; Chatnalkar, Soumya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-c87ad186ad938123b550bc2befe58f30e9cfa950000a27f9359915ce05687ce03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>2018 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroendocrine tumors</topic><topic>Proctology</topic><topic>Robotic surgery</topic><topic>Surgery</topic><topic>Tumors</topic><topic>Visualization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arora, Eham</creatorcontrib><creatorcontrib>Bhandarwar, Ajay</creatorcontrib><creatorcontrib>Wagh, Amol</creatorcontrib><creatorcontrib>Gandhi, Saurabh</creatorcontrib><creatorcontrib>Patel, Chintan</creatorcontrib><creatorcontrib>Gupta, Shubham</creatorcontrib><creatorcontrib>Talwar, Gagandeep</creatorcontrib><creatorcontrib>Agarwal, Jasmine</creatorcontrib><creatorcontrib>Rathore, Jai</creatorcontrib><creatorcontrib>Chatnalkar, Soumya</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arora, Eham</au><au>Bhandarwar, Ajay</au><au>Wagh, Amol</au><au>Gandhi, Saurabh</au><au>Patel, Chintan</au><au>Gupta, Shubham</au><au>Talwar, Gagandeep</au><au>Agarwal, Jasmine</au><au>Rathore, Jai</au><au>Chatnalkar, Soumya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>32</volume><issue>11</issue><spage>4649</spage><epage>4657</epage><pages>4649-4657</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29943065</pmid><doi>10.1007/s00464-018-6309-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5120-3356</orcidid></addata></record> |
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| subjects | 2018 SAGES Oral Abdominal Surgery Gastroenterology Gynecology Hepatology Laparoscopy Medicine Medicine & Public Health Neuroendocrine tumors Proctology Robotic surgery Surgery Tumors Visualization |
| title | Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases |
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