Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience
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 identif...
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| Veröffentlicht in: | Journal of robotic surgery 2023-04, Vol.17 (2), p.687-694 |
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| creator | Amara, Nordine Al Youssef, Tarek Massa, Jordan Fidjel, Aouad Khoury, Elias El Patel, Belur Flais, Mathias Deswarte, Christophe |
| description | 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. Our retrospective, unicentric study was performed in consecutive localised prostate cancer RARP patients (stage T1/T2, prostate-specific antigen |
| doi_str_mv | 10.1007/s11701-022-01483-w |
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t
test determined the significance of changes in SHIM scores versus baseline. 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. 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.</description><identifier>ISSN: 1863-2491</identifier><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-022-01483-w</identifier><identifier>PMID: 36308595</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Abdomen ; Angiography ; Angiography - adverse effects ; Antigens ; Body mass index ; Cancer surgery ; Dissection ; Erectile dysfunction ; Erectile Dysfunction - etiology ; Fluorescence ; Humans ; Indocyanine Green ; Laparoscopy ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Original Article ; Patients ; Prostate cancer ; Prostatectomy - methods ; Prostatic Neoplasms - surgery ; Proteins ; Rectum ; Retrospective Studies ; Robotic Surgical Procedures - methods ; Robotics ; Robots ; Sexual health ; Surgeons ; Surgery ; Tumors ; Urological surgery ; Urology</subject><ispartof>Journal of robotic surgery, 2023-04, Vol.17 (2), p.687-694</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-97bd6fb9f1966a92a3289e96fefbeb9fb9a4777172d8ecf7f3ab0def192654d53</citedby><cites>FETCH-LOGICAL-c419t-97bd6fb9f1966a92a3289e96fefbeb9fb9a4777172d8ecf7f3ab0def192654d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11701-022-01483-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918718049?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21379,21380,27915,27916,33521,33522,33735,33736,41479,42548,43650,43796,51310,64374,64376,64378,72230</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36308595$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amara, Nordine</creatorcontrib><creatorcontrib>Al Youssef, Tarek</creatorcontrib><creatorcontrib>Massa, Jordan</creatorcontrib><creatorcontrib>Fidjel, Aouad</creatorcontrib><creatorcontrib>Khoury, Elias El</creatorcontrib><creatorcontrib>Patel, Belur</creatorcontrib><creatorcontrib>Flais, Mathias</creatorcontrib><creatorcontrib>Deswarte, Christophe</creatorcontrib><title>Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><addtitle>J Robot Surg</addtitle><description>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. Our retrospective, unicentric study was performed in 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 (SHIM) 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. 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. 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.</description><subject>Abdomen</subject><subject>Angiography</subject><subject>Angiography - adverse effects</subject><subject>Antigens</subject><subject>Body mass index</subject><subject>Cancer surgery</subject><subject>Dissection</subject><subject>Erectile dysfunction</subject><subject>Erectile Dysfunction - etiology</subject><subject>Fluorescence</subject><subject>Humans</subject><subject>Indocyanine Green</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Original Article</subject><subject>Patients</subject><subject>Prostate cancer</subject><subject>Prostatectomy - methods</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Proteins</subject><subject>Rectum</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robotics</subject><subject>Robots</subject><subject>Sexual health</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tumors</subject><subject>Urological surgery</subject><subject>Urology</subject><issn>1863-2491</issn><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kctu1TAQhiMEoqXwAiyQJTZsAr4kccwOVVwqVWID62gSj09dJfbBdlrOg_I-THrKRSxYeWR__z8z_qvqueCvBef6TRZCc1FzKWsuml7Vtw-qU9F3qpaNEQ__qk-qJzlfc97qVonH1YnqFO9b055WPy5CSRD3mKD4G2QQdj7uEuyvDiw6Vq6QBVxTvIE8rTMkNq7BzsjW7MOO-WDjdIDgA7JdQgyktySAVPvgEiS0zM1rTJgnDBMyv-zJCzNxUOLiJ5iZ9TnjVHwMzK5ps01xjKWGnH0u5JDA3oEkzQUKsXE5vKXmvni6nmaqtnf8Tmv4rc_T6pGDOeOz-_Os-vrh_ZfzT_Xl548X5-8u66kRptRGj7Zzo3HCdB0YCUr2Bk3n0I1I16OBRmsttLQ9Tk47BSO3SLjs2sa26qx6dfSl0b6tmMuweNp0niFgXPMgteJKKCkUoS__Qa_jmgJNN0gjei163hii5JGaaNec0A375BdIh0HwYQt9OIY-UOjDXejDLYle3Fuv44L2t-RXygSoI5D32_9i-tP7P7Y_AdXVwIc</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Amara, Nordine</creator><creator>Al Youssef, Tarek</creator><creator>Massa, Jordan</creator><creator>Fidjel, Aouad</creator><creator>Khoury, Elias El</creator><creator>Patel, Belur</creator><creator>Flais, Mathias</creator><creator>Deswarte, Christophe</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope></search><sort><creationdate>20230401</creationdate><title>Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience</title><author>Amara, Nordine ; 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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. Our retrospective, unicentric study was performed in 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 (SHIM) 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. 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. 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.</abstract><cop>London</cop><pub>Springer London</pub><pmid>36308595</pmid><doi>10.1007/s11701-022-01483-w</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Angiography Angiography - adverse effects Antigens Body mass index Cancer surgery Dissection Erectile dysfunction Erectile Dysfunction - etiology Fluorescence Humans Indocyanine Green Laparoscopy Male Medical imaging Medicine Medicine & Public Health Minimally Invasive Surgery Original Article Patients Prostate cancer Prostatectomy - methods Prostatic Neoplasms - surgery Proteins Rectum Retrospective Studies Robotic Surgical Procedures - methods Robotics Robots Sexual health Surgeons Surgery Tumors Urological surgery Urology |
| title | Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience |
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