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Nayyar R, Das CJ, Gupta P. A novel method of using indocyanine green fluorescence technique for nephron-sparing surgery. Indian J Urol 2025; 41:148-150. [PMID: 40292366 PMCID: PMC12021360 DOI: 10.4103/iju.iju_241_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/11/2024] [Accepted: 10/24/2024] [Indexed: 04/30/2025] Open
Abstract
Two complex small renal masses were operated using a novel method of utilising indocyanine green fluorescence for nephron-sparing surgery (NSS), overcoming its current limitations of short duration of effect and non-enhancement of the tumor. The dye was emulsified with ethiodized oil and a 1:1 mixture was administered on the morning of the surgery using superselective cannulation of the direct tumoral blood supply. The fluorescence could be used throughout the entire course of the surgery irrespective of arterial clamping, allowing quick tumor identification, edge marking, and near-enucleation over enucleoresection. This novel method has the potential to aid the surgeon during various critical steps of NSS.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J. Das
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Joffe BI, Li G, Gorroochurn P, DeCastro GJ, Lenis AT, McKiernan JM, Anderson CB. The impact of indocyanine green on partial nephrectomy perioperative outcomes. J Robot Surg 2025; 19:78. [PMID: 39987334 DOI: 10.1007/s11701-025-02242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 02/12/2025] [Indexed: 02/24/2025]
Abstract
We conducted a retrospective analysis of the impact of indocyanine green (ICG) on perioperative outcomes in partial nephrectomy. The utility of ICG in partial nephrectomy remains unclear. We performed a retrospective cohort study of all patients at a single institution who underwent laparoscopic or robotic partial nephrectomy in 2014-2019. Some surgeons used ICG while others did not. Outcomes of interest were estimated blood loss, positive surgical margins, ischemia time, and postoperative kidney function. We used multivariate regression to assess ICG use and outcomes. We identified 150 patients meeting inclusion criteria. The majority of cases (58%) used ICG. Patients who did and did not receive ICG were similar in age, sex, and histologic subtype. Median estimated blood loss was 100 mL (IQR 50-200), 9% had a positive surgical margin, and median ischemia time was 21 min (IQR 16-26). Of those with renal function follow-up, 17% had increased chronic kidney disease stage and mean percent creatinine change was + 4.7 ± 14.9%. On multivariate analysis, ICG use was associated with change in CKD stage (OR 9.9, 95% CI 1.0-93.9, p = 0.05). It was not associated with positive surgical margin status (OR 1.20, 95% CI 0.38-3.85, p = 0.755), percent change creatinine (beta 5.18, 95% CI -1.87-12.23, p = 0.155), ischemia time (beta 0.86, 95% CI - 1.38-3.09, p = 0.45), or EBL (beta - 0.13, 95% CI - 0.53-0.28, p = 0.53). We observed a difference in CKD change according to ICG in partial nephrectomy, but not other perioperative outcomes. ICG may have impacted surgical decision-making in unmeasured ways but did not significantly affect perioperative outcomes.
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Affiliation(s)
- Benjamin I Joffe
- Department of Urology, NewYork-Presbyterian/Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, USA.
| | - Gen Li
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Prakash Gorroochurn
- Mailman School of Public Health, Department of Biostatistics, Columbia University, New York, NY, USA
| | - Guarionex Joel DeCastro
- Department of Urology, NewYork-Presbyterian/Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, USA
| | - Andrew T Lenis
- Department of Urology, NewYork-Presbyterian/Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, USA
| | - James M McKiernan
- Department of Urology, NewYork-Presbyterian/Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, USA
| | - Christopher B Anderson
- Department of Urology, NewYork-Presbyterian/Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, USA
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Qu H, Wang K, Hu B. Meta-analysis of clinical outcomes of robot-assisted partial nephrectomy and classical open partial nephrectomy. Int J Surg 2024; 110:6268-6281. [PMID: 38573087 PMCID: PMC11487007 DOI: 10.1097/js9.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Robotic-assisted partial nephrectomy (RAPN) has emerged as a promising alternative to classical partial nephrectomy (CPN). AIM This study aimed to compare the outcomes of RAPN and CPN for treating localized renal tumors through a meta-analysis of available literature. METHODS Chinese databases, such as CNKI, Chinese Science and Technology Periodicals Database (VIP), and Wanfang Full-text Database, were searched using Chinese search terms, and all published articles on PubMed and Web of Science were searched using English search terms. Articles on Localized Renal Tumors were included. RevMan5.3 software was used for meta-analysis. The funnel plots were drawn using Stata software to assess publication bias. OUTCOMES This study aimed to identify the differences between robotic-assisted partial nephrectomy and classic partial nephrectomy in patients with localized renal tumors. RESULTS In total, 67 articles with 17 677 patients were included. The results demonstrate the advantages of RAPN over CPN for localized renal tumors. Compared to CPN and RAPN had significant differences in intraoperative blood loss, hospital stay duration, incidence of perioperative complications, and proportion of patients requiring blood transfusion. Regarding surgical outcomes, RAPN showed more favorable results regarding the incidence of positive resection margins, postoperative decline in glomerular filtration rate (GFR), postoperative local recurrence rate, and proportion of Trifecta achieved. However, there was no significant difference between RAPN and CPN regarding 5-year tumor-specific survival rates. CLINICAL IMPLICATIONS The study suggests that robotic-assisted partial nephrectomy is a viable alternative to classic surgery for renal tumors. STRENGTHS AND LIMITATIONS The strengths of this study are the use of a comprehensive search strategy and the inclusion of studies published in both English and Chinese. The limitations of this study are the small sample size and the need for long-term follow-up data. CONCLUSION RAPN and CPN have similar overall survival outcomes for treating localized renal tumors. However, RAPN may offer advantages in terms of perioperative outcomes and preservation of renal function. Further studies are needed to confirm these findings and to identify the optimal surgical approach for individual patients.
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Affiliation(s)
| | | | - Bin Hu
- Department of Urological Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, People’s Republic of China
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Tappero S, Fallara G, Chierigo F, Micalef A, Ambrosini F, Diaz R, Dorotei A, Pompeo E, Limena A, Bravi CA, Longoni M, Piccinelli ML, Barletta F, Albano L, Mazzone E, Dell'Oglio P. Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes? Eur J Nucl Med Mol Imaging 2024; 51:3061-3078. [PMID: 38607386 DOI: 10.1007/s00259-024-06706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. METHODS A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. RESULTS Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). CONCLUSIONS Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Chierigo
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Micalef
- Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Francesca Ambrosini
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Raquel Diaz
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Dorotei
- Department of Orthopaedics, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Limena
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Northampton General Hospital, Northampton, UK
- Department of Urology, Royal Marsden Foundation Trust, London, UK
| | - Mattia Longoni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Ram AS, Matuszewska K, McKenna C, Petrik J, Oblak ML. Validation of a semi-quantitative scoring system and workflow for analysis of fluorescence quantification in companion animals. Front Vet Sci 2024; 11:1392504. [PMID: 39144083 PMCID: PMC11322124 DOI: 10.3389/fvets.2024.1392504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/11/2024] [Indexed: 08/16/2024] Open
Abstract
Significance Many commercially available near-infrared (NIR) fluorescence imaging systems lack algorithms for real-time quantifiable fluorescence data. Creation of a workflow for clinical assessment and post hoc analysis may provide clinical researchers with a method for intraoperative fluorescence quantification to improve objective outcome measures. Aim Scoring systems and verified image analysis are employed to determine the amount and intensity of fluorescence within surgical specimens both intra and postoperatively. Approach Lymph nodes from canine cancer patients were obtained during lymph node extirpation following peritumoral injection of indocyanine green (ICG). First, a semi-quantitative assessment of surface fluorescence was evaluated. Images obtained with a NIR exoscope were analysed to determine fluorescence thresholds and measure fluorescence amount and intensity. Results Post hoc fluorescence quantification (threshold of Hue = 165-180, Intensity = 30-255) displayed strong agreement with semi-quantitative scoring (k = 0.9734, p < 0.0001). Fluorescence intensity with either threshold of 35-255 or 45-255 were significant predictors of fluorescence and had high sensitivity and specificity (p < 0.05). Fluorescence intensity and quantification had a strong association (p < 0.001). Conclusion The validation of the semi-quantitative scoring system by image analysis provides a method for objective in situ observation of tissue fluorescence. The utilization of thresholding for ICG fluorescence intensity allows post hoc quantification of fluorescence when not built into the imaging system.
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Affiliation(s)
- Ann S. Ram
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Kathy Matuszewska
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Charly McKenna
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Jim Petrik
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Michelle L. Oblak
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
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Egen L, Demmel GS, Grilli M, Studier-Fischer A, Nickel F, Haney CM, Mühlbauer J, Hartung FO, Menold HS, Piazza P, Rivas JG, Checcucci E, Puliatti S, Belenchon IR, Taratkin M, Rodler S, Cacciamani G, Michel MS, Kowalewski KF. Biophotonics-Intraoperative Guidance During Partial Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2024; 10:248-258. [PMID: 38278713 DOI: 10.1016/j.euf.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT Partial nephrectomy (PN) with intraoperative guidance by biophotonics has the potential to improve surgical outcomes due to higher precision. However, its value remains unclear since high-level evidence is lacking. OBJECTIVE To provide a comprehensive analysis of biophotonic techniques used for intraoperative real-time assistance during PN. EVIDENCE ACQUISITION We performed a comprehensive database search based on the PICO criteria, including studies published before October 2022. Two independent reviewers screened the titles and abstracts followed by full-text screening of eligible studies. For a quantitative analysis, a meta-analysis was conducted. EVIDENCE SYNTHESIS In total, 35 studies were identified for the qualitative analysis, including 27 studies on near-infrared fluorescence (NIRF) imaging using indocyanine green, four studies on hyperspectral imaging, two studies on folate-targeted molecular imaging, and one study each on optical coherence tomography and 5-aminolevulinic acid. The meta-analysis investigated seven studies on selective arterial clamping using NIRF. There was a significantly shorter warm ischemia time in the NIRF-PN group (mean difference [MD]: -2.9; 95% confidence interval [CI]: -5.6, -0.1; p = 0.04). No differences were noted regarding transfusions (odds ratio [OR]: 0.5; 95% CI: 0.2, 1.7; p = 0.27), positive surgical margins (OR: 0.7; 95% CI: 0.2, 2.0; p = 0.46), or major complications (OR: 0.4; 95% CI: 0.1, 1.2; p = 0.08). In the NIRF-PN group, functional results were favorable at short-term follow-up (MD of glomerular filtration rate decline: 7.6; 95% CI: 4.6, 10.5; p < 0.01), but leveled off at long-term follow-up (MD: 7.0; 95% CI: -2.8, 16.9; p = 0.16). Remarkably, these findings were not confirmed by the included randomized controlled trial. CONCLUSIONS Biophotonics comprises a heterogeneous group of imaging modalities that serve intraoperative decision-making and guidance. Implementation into clinical practice and cost effectiveness are the limitations that should be addressed by future research. PATIENT SUMMARY We reviewed the application of biophotonics during partial removal of the kidney in patients with kidney cancer. Our results suggest that these techniques support the surgeon in successfully performing the challenging steps of the procedure.
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Affiliation(s)
- Luisa Egen
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
| | - Greta S Demmel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Caelan M Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Mühlbauer
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Friedrich O Hartung
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Hanna S Menold
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Pietro Piazza
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Juan Gomez Rivas
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Enrico Checcucci
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Stefano Puliatti
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University of Modena, and Reggio Emilia, Modena, Italy
| | - Ines Rivero Belenchon
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Mark Taratkin
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
| | - Severin Rodler
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University Hospital LMU Munich, Munich, Germany
| | - Giovanni Cacciamani
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany; Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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Thakker PU, O’Rourke TK, Hemal AK. Technologic advances in robot-assisted nephron sparing surgery: a narrative review. Transl Androl Urol 2023; 12:1184-1198. [PMID: 37554533 PMCID: PMC10406549 DOI: 10.21037/tau-23-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Nephron sparing surgery (NSS) is the preferred management for clinical stage T1 (cT1) renal masses. In recent years, indications have expanded to larger and more complex renal tumors. In an effort to provide optimal patient outcomes, urologists strive to achieve the pentafecta when performing partial nephrectomy. This has led to the continuous technologic advancement and technique refinement including the use of augmented reality, ultrasound techniques, changes in surgical approach and reconstruction, uses of novel fluorescence marker guided imaging, and implementation of early recovery after surgery (ERAS) protocols. The aim of this narrative review is to provide an overview of the recent advances in pre-, intra-, and post-operative management and approaches to managing patients with renal masses undergoing NSS. METHODS We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010 to 2022 without limitation on study design. We included only full-text English articles published in peer-reviewed journals. KEY CONTENT AND FINDINGS Partial nephrectomy is currently prioritized for cT1a renal masses; however, indications have been expanding due to a greater understanding of anatomy and technologic advances. Recent studies have demonstrated that improvements in imaging techniques utilizing cross-sectional imaging with three-dimensional (3D) reconstruction, use of color doppler intraoperative ultrasound, and newer studies emerging using contrast enhanced ultrasound play important roles in certain subsets of patients. While indocyanine green administration is commonly used, novel fluorescence-guided imaging including folate receptor-targeting fluorescence molecules are being investigated to better delineate tumor-parenchyma margins. Augmented reality has a developing role in patient and surgical trainee education. While pre-and intra-operative imaging have shown to be promising, near infrared guided segmental and sub-segmental vessel clamping has yet to show significant benefit in patient outcomes. Studies regarding reconstructive techniques and replacement of reconstruction with sealing agents have a promising future. Finally, ERAS protocols have allowed earlier discharge of patients without increasing complications while improving cost burden. CONCLUSIONS Advances in NSS have ranged from pre-operative imaging techniques to ERAS protocols Further prospective investigations are required to determine the impact of novel imaging, in-vivo fluorescence biomarker use, and reconstructive techniques on achieving the pentafecta of NSS.
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Affiliation(s)
- Parth Udayan Thakker
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Timothy Kirk O’Rourke
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ashok Kumar Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
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9
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Licari LC, Bologna E, Proietti F, Flammia RS, Bove AM, D'annunzio S, Tuderti G, Leonardo C. Exploring the Applications of Indocyanine Green in Robot-Assisted Urological Surgery: A Comprehensive Review of Fluorescence-Guided Techniques. SENSORS (BASEL, SWITZERLAND) 2023; 23:5497. [PMID: 37420664 DOI: 10.3390/s23125497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023]
Abstract
This comprehensive review aims to explore the applications of indocyanine green (ICG) in robot-assisted urological surgery through a detailed examination of fluorescence-guided techniques. An extensive literature search was conducted in PubMed/MEDLINE, EMBASE and Scopus, using keywords such as "indocyanine green," "ICG", "NIRF", "Near Infrared Fluorescence", "robot-assisted", and "urology". Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. The integration of the Firefly® technology in the Da Vinci® robotic system has opened new avenues for the advancement and exploration of different urological procedures. ICG is a fluorophore widely used in near-infrared fluorescence-guided techniques. The synergistic combination of intraoperative support, safety profiles and widespread availability comprises an additional asset that empowers ICG-guided robotic surgery. This overview of the current state of the art illustrates the potential advantages and broad applications of combining ICG-fluorescence guidance with robotic-assisted urological surgery.
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Affiliation(s)
- Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Rocco Simone Flammia
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Simone D'annunzio
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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10
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Feng J, Yang W, Qin H, Xu J, Liu S, Han J, Li N, He L, Wang H. Clinical application of indocyanine green fluorescence imaging navigation for pediatric renal cancer. Front Pediatr 2023; 11:1108997. [PMID: 37215593 PMCID: PMC10196123 DOI: 10.3389/fped.2023.1108997] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Background Indocyanine Green (ICG) fluorescence imaging has been widely used in the surgical treatment of adult renal cancers, but its application in pediatric renal cancers has rarely been reported. This study aims to summarize the experience of ICG fluorescence imaging in pediatric renal cancers and explores its safety and feasibility. Methods The clinical features, surgical information, ICG administration regimen, near infrared radiography data in vivo and ex vivo and pathological results of children with renal cancers using ICG navigation were analyzed and summarized. Results There were 7 cases of renal cancer, including 4 cases of Wilms tumor (WT), 1 case of malignant rhabdoid tumor of the kidney (MRTK) and 2 cases of renal cell carcinoma (RCC). By intraoperative intravenous injection of ICG from 2.5 to 5 mg (0.05-0.67 mg/kg), the tumors were visualized in 6 cases in vivo or ex vivo, and the tumor visualization failed in 1 case due to renal artery embolization before operation. By injecting 5 mg ICG into the normal renal tissue during the operation, 3 patients achieved fluorescent localization of sentinel lymph nodes. No ICG-related adverse reactions were found in any of the patients during or after operation. Conclusions ICG fluorescence imaging is safe and feasible for renal cancers in children. Intraoperative administration can achieve tumor and sentinel lymph node visualization which will facilitate the development of nephron sparing surgery (NSS). However, the technique is affected by ICG dose, anatomical conditions around the tumor, and renal blood flow. A proper dose of ICG and the complete removal of perirenal fat are helpful for the fluorescence imaging of the tumor. It has potential in the operation of renal cancer in children.
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Affiliation(s)
- Jun Feng
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jiatong Xu
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Shan Liu
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jianyu Han
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ning Li
- Department of Surgical Urology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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11
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Kim K, Han KN, Choi BH, Rho J, Lee JH, Eo JS, Kim C, Kim BM, Jeon OH, Kim HK. Identification of Metastatic Lymph Nodes Using Indocyanine Green Fluorescence Imaging. Cancers (Basel) 2023; 15:cancers15071964. [PMID: 37046626 PMCID: PMC10093445 DOI: 10.3390/cancers15071964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Indocyanine green (ICG) has been used to detect several types of tumors; however, its ability to detect metastatic lymph nodes (LNs) remains unclear. Our goal was to determine the feasibility of ICG in detecting metastatic LNs. We established a mouse model and evaluated the potential of ICG. The feasibility of detecting metastatic LNs was also evaluated in patients with lung or esophageal cancer, detected with computed tomography (CT) or positron-emission tomography (PET)/CT, and scheduled to undergo surgical resection. Tumors and metastatic LNs were successfully detected in the mice. In the clinical study, the efficacy of ICG was evaluated in 15 tumors and fifty-four LNs with suspected metastasis or anatomically key regional LNs. All 15 tumors were successfully detected. Among the fifty-four LNs, eleven were pathologically confirmed to have metastasis; all eleven were detected in ICG fluorescence imaging, with five in CT and seven in PET/CT. Furthermore, thirty-four LNs with no signals were pathologically confirmed as nonmetastatic. Intravenous injection of ICG may be a useful tool to detect metastatic LNs and tumors. However, ICG is not a targeting agent, and its relatively low fluorescence makes it difficult to use to detect tumors in vivo. Therefore, further studies are needed to develop contrast agents and devices that produce increased fluorescence signals.
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12
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Abdelhafeez AH, Murphy AJ, Brennan R, Santiago TC, Lu Z, Krasin MJ, Bissler JJ, Gleason JM, Davidoff AM. Indocyanine green-guided nephron-sparing surgery for pediatric renal tumors. J Pediatr Surg 2022; 57:174-178. [PMID: 34518021 DOI: 10.1016/j.jpedsurg.2021.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Indocyanine green (ICG), a water-soluble tricarbocyanine fluorophore, is being increasingly used for tumor localization based on its passive intra-tumoral accumulation due to enhanced permeability and retention in tumor tissue. Therefore, we hypothesized that ICG can provide contrast to facilitate accurate, real-time recognition of renal tumors at the time of nephron-sparing surgery in children. METHODS This retrospective study examined the feasibility of ICG in guiding nephron-sparing surgery for pediatric renal tumors. RESULTS We reviewed the medical records of 8 pediatric patients with renal tumors in 12 kidneys. Intraoperative localization of tumor with near infrared guidance was successful in all 12 kidneys. However, we consistently found an inverse pattern of near infrared signal in which the normal kidney demonstrated increased fluorescent signal relative to the kidney tumor. CONCLUSIONS Fluorescence-guided renal tumor delineation is unique because it has an inverse pattern of near infrared signal in which the normal kidney demonstrates increased signal relative to the adjacent tumor. Nevertheless fluorescence-guided distinguishing of renal tumor from surrounding normal kidney is feasible.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA.
| | - Andrew J Murphy
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
| | - Rachel Brennan
- Department of Oncology, MS 260, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Teresa C Santiago
- Department of Pathology, MS 250, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Zhaohua Lu
- Department of Biostatistics, MS 768, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Matthew J Krasin
- Department of Radiation Oncology, MS 210, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - John J Bissler
- Division of Pediatric Nephrology, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph M Gleason
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Urology, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
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13
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Teranishi K. Near-Infrared Fluorescence Imaging of Renal Cell Carcinoma with ASP5354 in a Mouse Model for Intraoperative Guidance. Int J Mol Sci 2022; 23:ijms23137228. [PMID: 35806231 PMCID: PMC9266568 DOI: 10.3390/ijms23137228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Renal cell carcinoma is a prevalent disease associated with high morbidity and mortality rates. Partial nephrectomy is a first-line surgical option because it allows the preservation of renal function. Clear differentiation between normal and cancerous tissues is critical for increasing the negative margin rates. This study investigated the capability of the near-infrared (NIR) fluorescent imaging agent ASP5354 for in vivo fluorescence imaging of renal cell carcinoma. ASP5354 at a single dose of 12 nmol (0.037 mg)/kg body weight was intravenously administered to healthy and orthotopic renal cell carcinoma mice under anesthesia. NIR images of the abdominal cavity were obtained using a near-infrared fluorescence (NIRF) camera system. In addition, the cancerous kidneys were harvested, and the NIRF in their sections was measured using an NIRF microscope. Normal renal tissue emitted strong NIRF but the cancer tissue did not. The difference in NIRF intensity between the normal and cancer tissues clearly presented the boundary between the normal and cancer tissues in macro and micro NIRF imaging. ASP5354 can distinguish cancer tissue from normal tissue using NIRF. Thus, ASP5354 is a promising agent for renal cell carcinoma tissue imaging in partial nephrectomy for renal cell carcinoma patients.
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Affiliation(s)
- Katsunori Teranishi
- Graduate School of Bioresources, Mie University, 1577 Kurimamachiya, Tsu 514-8507, Mie, Japan
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14
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Puliatti S, Eissa A, Checcucci E, Piazza P, Amato M, Scarcella S, Rivas JG, Taratkin M, Marenco J, Rivero IB, Kowalewski KF, Cacciamani G, El-Sherbiny A, Zoeir A, El-Bahnasy AM, De Groote R, Mottrie A, Micali S. New imaging technologies for robotic kidney cancer surgery. Asian J Urol 2022; 9:253-262. [PMID: 36035346 PMCID: PMC9399539 DOI: 10.1016/j.ajur.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
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15
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Quan YH, Xu R, Choi BH, Rho J, Lee JH, Han KN, Choi YH, Kim BM, Kim HK. Fluorescence Imaging-Guided Identification of Thymic Masses Using Low-Dose Indocyanine Green. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11466-8. [PMID: 35262823 DOI: 10.1245/s10434-022-11466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging has been used to detect many types of tumors during surgery; however, there are few studies on thymic masses and the dose and time of ICG injection have not been optimized. OBJECTIVE We aimed to evaluate the optimal ICG injection dose and timing for detecting thymic masses during surgery. METHOD Forty-nine consecutive patients diagnosed with thymic masses on preoperative computed tomography (CT) and scheduled to undergo thymic cystectomy or thymectomy were included. Patients were administered 1, 2, or 5 mg/kg of ICG at different times. Thymic masses were observed during and after surgery using a near-infrared fluorescence imaging system, and the fluorescence signal tumor-to-normal ratio (TNR) was analyzed. RESULTS Among the 49 patients, 14 patients with thymic cysts showed negative fluorescence signals, 33 patients with thymoma or thymic carcinoma showed positive fluorescence signals, and 2 patients showed insufficient fluorescence signals. The diagnosis of thymic masses based on CT was correct in 32 (65%) of 49 cases; however, the differential diagnosis of thymic masses based on NIR signals was correct in 47 of 49 cases (96%), including 14 cases of thymic cysts (100%) and 33 cases of thymomas or thymic carcinomas (94%). In addition, TNR was not affected by the time or dose of ICG injection, histological type, stage, or tumor size. CONCLUSIONS Low-dose intravenous injection of ICG at flexible time can detect thymic tumors. In addition, thymic cysts can be distinguished from thymomas or thymic carcinomas during surgery by the absence of ICG fluorescence signals.
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Affiliation(s)
- Yu Hua Quan
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Rong Xu
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Byeong Hyeon Choi
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jiyun Rho
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea
| | - Beop-Min Kim
- Department of Bio-Convergence, Korea University, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea.
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16
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Rho J, Quan YH, Choi BH, Han KN, Kim BM, Choi YH, Kim HK. Near-infrared fluorescent imaging with indocyanine green in rabbit and patient specimens of esophageal cancer. J Thorac Dis 2022; 13:6314-6322. [PMID: 34992811 PMCID: PMC8662470 DOI: 10.21037/jtd-21-790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
Background We aimed to assess the possibility of detecting esophageal cancer after intravenous injection of indocyanine green (ICG) in preclinical and clinical models. Methods Forty-five rabbits were surgically implanted with VX2 tumors into the esophageal muscular layer 2 weeks before esophagectomy. The rabbits received intravenous injection of ICG at doses of 1, 2, or 5 mg/kg at 3, 6, 12, 24, or 48 h before surgical removal of esophagus. Twelve patients scheduled to undergo esophagectomy were also enrolled, and all received 2 mg/kg of ICG intravenously at 3, 6, 12, or 24 h before surgical removal of esophagus. The fluorescence intensity was measured in all resected specimens from the rabbits and patients using a near-infrared (NIR) fluorescence imaging system after surgery. Results Esophageal tumors were successfully established in all rabbits, and fluorescent signals were detected in all animal and patient specimens. Tumor-to-normal ratio (TNR) analysis showed that higher doses resulted in a greater TNR. Injection of at least 2 mg/kg of ICG was required for clear visualization of the tumor, and the TNR was highest at 12 h after injection. The TNR in patients was also highest at 12 h (P=0.0004), with 2 mg/kg of ICG. None of the patients had major complications following ICG injection. Conclusions NIR fluorescence imaging can be used to visualize esophageal cancer after systemic injection of ICG. ICG at 2 mg/kg at 12 h is optimal for tumor detection. However, since the clinical trials were conducted in a small number of patients, further studies are needed in larger populations.
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Affiliation(s)
- Jiyun Rho
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Yu Hua Quan
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Byeong Hyeon Choi
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Beop-Min Kim
- Department of Interdisciplinary Bio/Micro Technology, College of Engineering, Korea University, Seoul, South Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
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17
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Lee YJ, van den Berg NS, Orosco RK, Rosenthal EL, Sorger JM. A narrative review of fluorescence imaging in robotic-assisted surgery. LAPAROSCOPIC SURGERY 2021; 5. [PMID: 34549180 PMCID: PMC8452263 DOI: 10.21037/ls-20-98] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective In this review, we provide examples of applications of fluorescence imaging in urologic, gynecologic, general, and endocrine surgeries. Background While robotic-assisted surgery has helped increase the availability of minimally invasive procedures across surgical specialties, there remains an opportunity to reduce adverse events associated with open, laparoscopic, and robotic-assisted methods. In 2011, fluorescence imaging was introduced as an option to the da Vinci Surgical System, and has been standard equipment since 2014. Without interfering with surgical workflow, this fluorescence technology named Firefly® allows for acquisition and display of near-infrared fluorescent signals that are co-registered with white light endoscopic images. As a result, robotic surgeons of all specialties have been able to explore the clinical utility of fluorescence guided surgery. Methods Literature searches were performed using the PubMed and MEDLINE databases using the keywords "robotic-assisted fluorescence surgery", "ICG robotic surgery", and "fluorescence guided surgery" covering the years 2011-2020. Conclusions Real-time intraoperative fluorescence guidance has shown great potential in helping guide surgeons in both simple and complex surgical interventions. Indocyanine green is one of the most widely-used imaging agents in fluorescence guided surgery, and other targeted, near-infrared imaging agents are in various stages of development. Fluorescence is becoming a reliable tool that can help surgeons in their decision-making process in some specialties, while explorations continue in others.
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Affiliation(s)
- Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | | | - Ryan K Orosco
- Moores Cancer Center, La Jolla, CA, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Jonathan M Sorger
- Department of Research, Intuitive Surgical, Inc., Sunnyvale, CA, USA
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18
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Rossi L, Fregoli L, Bacca A, Bakkar S, Bernini G, Materazzi G. Indocyanine green fluorescence: an additional tool for endoscopic adrenalectomy. ANZ J Surg 2021; 91:1655-1658. [PMID: 34506065 DOI: 10.1111/ans.16725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Lorenzo Fregoli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandra Bacca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Giampaolo Bernini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Liu CH, Grodzinski P. Nanotechnology for Cancer Imaging: Advances, Challenges, and Clinical Opportunities. Radiol Imaging Cancer 2021; 3:e200052. [PMID: 34047667 PMCID: PMC8183257 DOI: 10.1148/rycan.2021200052] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/28/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022]
Abstract
Nanoparticle (NP) imaging applications have the potential to improve cancer diagnostics, therapeutics, and treatment management. In biomedical research and clinical practice, NPs can serve as labels or labeled carriers for monitoring drug delivery or serve as imaging agents for enhanced imaging contrast, as well as providing improved signal sensitivity and specificity for in vivo imaging of molecular and cellular processes. These qualities offer exciting opportunities for NP-based imaging agents to address current limitations in oncologic imaging. Despite substantial advancements in NP design and development, very few NP-based imaging agents have translated into clinics within the past 5 years. This review highlights some promising NP-enabled imaging techniques and their potential to address current clinical cancer imaging limitations. Although most examples provided herein are from the preclinical space, discussed imaging solutions could offer unique in vivo tools to solve biologic questions, improve cancer treatment effectiveness, and inspire clinical translation innovation to improve patient care. Keywords: Molecular Imaging-Cancer, Molecular Imaging-Nanoparticles, Molecular Imaging-Optical Imaging, Metastases, Oncology, Surgery, Treatment Effects.
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Affiliation(s)
- Christina H. Liu
- From the Cancer Imaging Program, National Cancer Institute, National
Institutes of Health, 9609 Medical Center Dr, Room 4W216, Rockville, MD
20850
| | - Piotr Grodzinski
- From the Cancer Imaging Program, National Cancer Institute, National
Institutes of Health, 9609 Medical Center Dr, Room 4W216, Rockville, MD
20850
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20
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Goldstein SD, Heaton TE, Bondoc A, Dasgupta R, Abdelhafeez A, Davidoff AM, Lautz TB. Evolving applications of fluorescence guided surgery in pediatric surgical oncology: A practical guide for surgeons. J Pediatr Surg 2021; 56:215-223. [PMID: 33189300 DOI: 10.1016/j.jpedsurg.2020.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
Fluorescence-guided surgery (FGS) is an increasingly available and popular method of visual field augmentation. The basic premise of FGS entails injection of fluorescent indocyanine green (ICG) and subsequent detection with a near-infrared (NIR) camera. For pediatric surgical oncologists, FGS remains experimental but is a promising modality for identifying tumor margins, locating metastases, performing sentinel lymph node biopsies, protecting peritumoral structures of interest, and facilitating reconstruction. Familiarity with basic ICG pharmacokinetics and NIR detection optics is critical for surgeons wishing to judiciously use FGS, as its success is firmly grounded in a thorough understanding of its capabilities and limitations. In this practical guide, we outline several well-described and innovative FGS applications by disease type, including their methods of administration, modes of detection, and typical ICG dosing paradigms. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Seth D Goldstein
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander Bondoc
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Roshni Dasgupta
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Timothy B Lautz
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL.
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21
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Bukavina L, Mishra K, Calaway A, Ponsky L. Robotic Partial Nephrectomy: Update on Techniques. Urol Clin North Am 2020; 48:81-90. [PMID: 33218596 DOI: 10.1016/j.ucl.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Surgical techniques for robot-assisted partial nephrectomy are driven by the aims of simplifying the most challenging surgical steps, maximizing functional and oncologic outcomes, and consistently pushing the envelope on possibilities. Over the past several years, we have seen an emergence in not only innovation in surgical technique, and robotic platforms, but integration of a variety of imaging techniques. We believe with developing robotic expertise, practicing urologists will continue to push the envelope in nephron preservation and complication-free recovery.
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Affiliation(s)
- Laura Bukavina
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kirtishri Mishra
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam Calaway
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lee Ponsky
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Suite 411, Cleveland, OH 44106, USA.
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22
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Connor MJ, Dasgupta P, Ahmed HU, Raza A. Autonomous surgery in the era of robotic urology: friend or foe of the future surgeon? Nat Rev Urol 2020; 17:643-649. [DOI: 10.1038/s41585-020-0375-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
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Sentell KT, Ferroni MC, Abaza R. Near-infrared fluorescence imaging for intraoperative margin assessment during robot-assisted partial nephrectomy. BJU Int 2020; 126:259-264. [PMID: 32320124 DOI: 10.1111/bju.15089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To demonstrate how using a standardised dosing strategy of indocyanine green (ICG) dye with near-infrared fluorescence (NIRF) imaging can be used to differentiate renal tumours from normal renal parenchyma during robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS We reviewed a prospectively collected database of 361 consecutive RAPNs using NIRF between June 2011 and March 2018, and determined the rate at which differential fluorescence was achieved. Tumour and kidney fluorescence or afluorescence were recorded intraoperatively and compared to histological results on final pathology. RESULTS Of 330 tumours, after 31 exclusions for nonvisible tumours due to adherent fat, completely intrarenal location or for incomplete data, 288 (87.3%) successfully exhibited differential fluorescence. Among the predominant histologies, 249 of 277 (89.9%) renal cell carcinomas did not fluoresce, as well as 23 of 32 (71.9%) oncocytomas. Real-time gross assessment of resection margin for fluorescence yielded a positive margin rate on final pathology of 0.30%. CONCLUSION When administered with a standardised ICG-dosing strategy, NIRF successfully achieved differential fluorescence in a large majority of tumours during RAPN with an exceedingly low positive margin rate.
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Affiliation(s)
- Katherine T Sentell
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Matthew C Ferroni
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Ronney Abaza
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
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Tuncel A, Balci M, Aykanat C, Aslan Y, Berker D, Guzel O. Laparoscopic partial adrenalectomy using near-infrared imaging: the initial experience. MINIM INVASIV THER 2019; 30:94-100. [PMID: 31825679 DOI: 10.1080/13645706.2019.1691016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION To present our initial clinical experience with laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging. MATERIAL AND METHODS A total of eight patients underwent transperitoneal laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging in our clinic. After 5 mg intravenous indocyanine green dye administration, we resected the mass under the guidance of near-infrared fluorescence imaging and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. RESULTS Seven patients underwent unilateral and one patient underwent bilateral laparoscopic partial adrenalectomy. The median tumor size was 43 mm. The surgery was successfully performed with negative margins in all patients. The tumors were hypofluorescent relative to normal adrenal tissue with indocyanine green dye with near-infrared fluorescence imaging in patients with Cushing's syndrome, aldosteronoma, and adrenal cyst. However, pheochromocytoma and angiomyolipoma were noted to be isoflourorescent and hyperfluorescent relative to normal adrenal parenchyma, respectively. CONCLUSIONS Laparoscopic partial adrenalectomy using intraoperative indocyanine green dye with near-infrared fluorescence imaging seems to be safe and feasible. This technology may ultimately be helpful in resecting lesions with more precise surgical margins by identifying the vascular structure during laparoscopic partial adrenalectomy. Abbreviations: LTA: Laparoscopic total adrenalectomy; LPA:Laparoscopic partial adrenalectomy; ICG: Indocynanine green; NIRF: Near-infrared fluorescence; HPA: Hypothalamic-pituitary-adrenal.
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Affiliation(s)
- Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Melih Balci
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Can Aykanat
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism Diseases, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozer Guzel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
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25
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Soga N, Inoko A, Furusawa J, Ogura Y. Evaluation to Differentiate between Tumor Lesions and the Parenchyma in Partial Nephrectomies for Renal Tumors Based on Quantitative Fluorescence Imaging Using Indocyanine Green Dye. Curr Urol 2019; 13:74-81. [PMID: 31768173 DOI: 10.1159/000499289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/19/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Near-infrared fluorescence imaging with indocyanine green is a useful tool during partial nephrectomy. Because an accurate method for judging hasn't been established yet, the success rate may be slightly different and inconsistent. Materials and Methods A total of 21 cases with suspected renal cancers who had undergone a partial nephrectomy were enrolled. We examined differences in the success rate between malignant lesions and the parenchyma by quantifying fluorescence in the pre-resection and ex vivo phases. Results Pre-resection imaging showed a significant degradation of fluorescence in the focused lesion in 76.2% (16/21) of cases. A significant degradation was observed in 73.7% (14/19) of the total malignant lesions, 70.5% (12/17) of cases with a clear cell lesion, 100% (2/2) of cases with non-clear cell lesions, and 100% (2/2) of benign angiomyolipomas. In contrast, imaging of the ex vivo resected specimens showed a significant degradation in fluorescence of the focused lesions in 85.7% (18/21) of cases. A significantly degradation was observed in 84.2% (16/19) of the total malignant lesions, 82.3% (14/17) of cases with a clear cell lesion, 100% (2/2) of cases with non-clear cell lesions, and 100% (2/2) of benign angiomyolipomas. Conclusion We firstly evaluated the efficacy of quantitative indocyanine green-based fluorescence as an objective method.
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Affiliation(s)
- Norihito Soga
- Department of Urology, Aichi Cancer Center Hospital, Division of Cancer Epidemiology and Prevention, Nagoya, Japan
| | - Akihito Inoko
- Aichi Cancer Center Research Institute, Division of Cancer Epidemiology and Prevention, Nagoya, Japan.,Division of Pathology, Aichi Medical University, Nagakute, Japan
| | - Jun Furusawa
- Department of Urology, Aichi Cancer Center Hospital, Division of Cancer Epidemiology and Prevention, Nagoya, Japan
| | - Yuji Ogura
- Department of Urology, Aichi Cancer Center Hospital, Division of Cancer Epidemiology and Prevention, Nagoya, Japan
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26
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Abstract
The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in many fields in adult surgery, such as sentinel lymph node mapping, intra-operative solid tumor identification, and organ perfusion assessment. However, the clinical application of ICG in pediatric surgery is just at the beginning. This review paper presents the advantages, current applications and potential developments of NIR fluorescence imaging with ICG in our field.
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Affiliation(s)
- C T Lau
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - D M Au
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - K K Y Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
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27
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Cacciamani GE, Shakir A, Tafuri A, Gill K, Han J, Ahmadi N, Hueber PA, Gallucci M, Simone G, Campi R, Vignolini G, Huang WC, Taylor J, Becher E, Van Leeuwen FWB, Van Der Poel HG, Velet LP, Hemal AK, Breda A, Autorino R, Sotelo R, Aron M, Desai MM, De Castro Abreu AL. Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus. World J Urol 2019; 38:883-896. [PMID: 31286194 DOI: 10.1007/s00345-019-02870-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/03/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The aim of the present study is to investigate the impact of the near-infrared (NIRF) technology with indocyanine green (ICG) in robotic urologic surgery by performing a systematic literature review and to provide evidence-based expert recommendations on best practices in this field. METHODS All English language publications on NIRF/ICG-guided robotic urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus® and Web of Science™ databases (up to April 2019). Experts in the field provided detailed pictures and intraoperative video-clips of different NIRF/ICG-guided robotic surgeries with recommendations for each procedure. A unique QRcode was generated and linked to each underlying video-clip. This new exclusive feature makes the present the first "dynamic paper" that merges text and figure description with their own video providing readers an innovative, immersive, high-quality and user-friendly experience. RESULTS Our electronic search identified a total of 576 papers. Of these, 36 studies included in the present systematic review reporting the use of NIRF/ICG in robotic partial nephrectomy (n = 13), robotic radical prostatectomy and lymphadenectomy (n = 7), robotic ureteral re-implantation and reconstruction (n = 5), robotic adrenalectomy (n = 4), robotic radical cystectomy (n = 3), penectomy and robotic inguinal lymphadenectomy (n = 2), robotic simple prostatectomy (n = 1), robotic kidney transplantation (n = 1) and robotic sacrocolpopexy (n = 1). CONCLUSION NIRF/ICG technology has now emerged as a safe, feasible and useful tool that may facilitate urologic robotic surgery. It has been shown to improve the identification of key anatomical landmarks and pathological structures for oncological and non-oncological procedures. Level of evidence is predominantly low. Larger series with longer follow-up are needed, especially in assessing the quality of the nodal dissection and the feasibility of the identification of sentinel nodes and the impact of these novel technologies on long-term oncological and functional outcomes.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - A Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Tafuri
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - K Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Han
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - N Ahmadi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Uro-Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - P A Hueber
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Gallucci
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - G Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - R Campi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Vignolini
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - W C Huang
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - J Taylor
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - E Becher
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - F W B Van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Interventional Molecular Imaging Laboratory, Leiden University Medical center, Leiden, The Netherlands.,Orsi Academy, Melle, Belgium
| | - H G Van Der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L P Velet
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | - A K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | - A Breda
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain
| | - R Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - R Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Aron
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M M Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A L De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kaplan-Marans E, Fulla J, Tomer N, Bilal K, Palese M. Indocyanine Green (ICG) in Urologic Surgery. Urology 2019; 132:10-17. [PMID: 31129192 DOI: 10.1016/j.urology.2019.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 01/06/2023]
Abstract
Indocyanine green (ICG) is a dye used for fluorescent-guided surgery. This review article addresses the recent surge in reported uses of ICG in various surgical fields and provides a comprehensive and up to date review of the uses of ICG in urologic surgery.
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Affiliation(s)
| | - Juan Fulla
- Department of Urology, Mount Sinai Health System, New York, NY
| | - Nir Tomer
- Department of Urology, Mount Sinai Health System, New York, NY
| | - Khawaja Bilal
- Department of Urology, Mount Sinai Health System, New York, NY
| | - Michael Palese
- Department of Urology, Mount Sinai Health System, New York, NY
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29
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Intraoperative ICG-fluorescence imaging for robotic-assisted urologic surgery: current status and review of literature. Int Urol Nephrol 2019; 51:765-771. [DOI: 10.1007/s11255-019-02126-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
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30
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Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy. Eur Urol Focus 2018; 4:960-968. [DOI: 10.1016/j.euf.2017.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
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31
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van Manen L, Handgraaf HJM, Diana M, Dijkstra J, Ishizawa T, Vahrmeijer AL, Mieog JSD. A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 2018; 118:283-300. [PMID: 29938401 PMCID: PMC6175214 DOI: 10.1002/jso.25105] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 12/14/2022]
Abstract
Near-infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Jan Sven David Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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32
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Abstract
With the ubiquitous use of cross-sectional abdominal imaging in recent years, the incidence of small renal masses (SRMs) has increased, and the evaluation and management of SRMs have become important clinical issues. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. In the past 20 years, surgical treatment of SRMs has transitioned from radical nephrectomy for all renal tumors, regardless of size, to elective partial nephrectomy whenever technically feasible. Additionally, newer approaches, including renal mass biopsy, active surveillance for select patients, and renal mass ablation, have been increasingly used. In this chapter, we review the current evidence-based papers covering aspects of the diagnosis and management of SRMs.
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Affiliation(s)
- Avinash Chenam
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 E. Duarte Rd, MOB L002H, Duarte, CA, 91010, USA
| | - Clayton Lau
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 E. Duarte Rd, MOB L002H, Duarte, CA, 91010, USA.
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33
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Near-infrared fluorescence with indocyanine green for diagnostics in urology: initial experience. Urologia 2017; 84:197-202. [PMID: 28525664 DOI: 10.5301/uj.5000235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Fluorescence imaging with indocyanine green is used in urology for the detection of sentinel lymph nodes and identification of prostate margins in radical prostatectomy for delineation of resection zone and selective clamping of vessels in partial nephrectomy; for identification and evaluation of length of ureteral strictures; for assessment of perfusion and viability of anastomoses during reconstructive stage of cystectomy. Safety of this technique is proven, while its diagnostic value and usefulness is still controversial. METHODS This pilot study of using the SPY Elite Fluorescence Imaging System for diagnostics was performed in the I.M. Sechenov First Moscow State Medical University. Ten patients were enrolled: four patients underwent retropubic RP and lymph node dissection, five patients underwent partial nephrectomy, and one patient underwent ureteroplasty. Fluorophore was injected transrectally with TRUS guidance during RP in order to assess the lymph nodes. During partial nephrectomy, the compound was injected intravenously to differentiate the tumor from parenchyma by its blood supply. During ureteroplasty, the indocyanine green solution was injected into the renal pelvis to dye the ureter and locate the stricture. RESULTS Sensitivity of this technique for visualization of sentinel lymph nodes was 100%, and specificity was 73.3%. In patients who underwent partial nephrectomy, all lesions were malignant and hypofluorescent when compared with healthy parenchyma. SPY allowed us to determine the location and extension of the stricture during ureteroplasty. No hypersensitivity reactions or complications were observed during injection of the compound.
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34
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Bates AS, Patel VR. Applications of indocyanine green in robotic urology. J Robot Surg 2016; 10:357-359. [PMID: 27664142 PMCID: PMC5108821 DOI: 10.1007/s11701-016-0641-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 02/03/2023]
Abstract
Indocyanine green is a fluorescent molecule with wide ranging applications in minimally invasive urological surgery. This article explores the utility of ICG assisted intraoperative fluorescence in robotic urology.
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Affiliation(s)
- Anthony S Bates
- Department of Urology, University Hospitals of Leicester, Leicester, UK. .,University of Oxford, Oxford, UK.
| | - Vipul R Patel
- Global Robotics Institute, Florida Hospital in Celebration, Orlando, FL, USA
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35
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Molecular Targeted Fluorescence-Guided Intraoperative Imaging of Bladder Cancer Nodal Drainage Using Indocyanine Green During Radical and Partial Cystectomy. Curr Urol Rep 2016; 17:74. [DOI: 10.1007/s11934-016-0633-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Cornejo-Dávila V, Nazmy M, Kella N, Palmeros-Rodríguez MA, Morales-Montor JG, Pacheco-Gahbler C. Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy. Actas Urol Esp 2016; 40:190-4. [PMID: 26598421 DOI: 10.1016/j.acuro.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. OBJECTIVE To demonstrate the implementation of fluorescence in nephron-sparing surgery. CASE REPORT This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. CONCLUSION Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results.
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Affiliation(s)
- V Cornejo-Dávila
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México.
| | - M Nazmy
- The Urology and Prostate Institute, San Antonio, Texas, Estados Unidos de, América
| | - N Kella
- The Urology Place , San Antonio, Texas, Estados Unidos de, América
| | - M A Palmeros-Rodríguez
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
| | - J G Morales-Montor
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
| | - C Pacheco-Gahbler
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
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37
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Kim HK, Quan YH, Choi BH, Park JH, Han KN, Choi Y, Kim BM, Choi YH. Intraoperative pulmonary neoplasm identification using near-infrared fluorescence imaging. Eur J Cardiothorac Surg 2015; 49:1497-502. [PMID: 26503731 DOI: 10.1093/ejcts/ezv367] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Near-infrared (NIR) fluorescence imaging provides surgeons with real-time visual information during surgery. The purpose of this pilot trial was to evaluate the safety and feasibility of the intraoperative detection of pulmonary neoplasms with NIR fluorescence imaging after low-dose indocyanine green (ICG) injection. METHODS Eleven consecutive patients who were scheduled to undergo resection of pulmonary neoplasms were enrolled in this study. ICG (1 mg/kg) was administered intravenously 1 day before surgery, and the retrieved surgical specimens were examined for fluorescence signalling by using NIR fluorescence imaging system on a back table in the operating room. We analysed the fluorescence intensity, pathology, size, depth from the pleural surface and metabolic activity of the pulmonary neoplasms. RESULTS Fluorescence signalling was detected in all specimens except in one from a patient with primary lung cancer. Two false-positive cases that presented no residual tumour with obstructive pneumonitis, after concurrent chemoradiation therapy for primary lung cancer before the operation, were identified, and their fluorescence intensity was 8.6 ± 0.4. The mean fluorescence intensity of the eight pulmonary tumours was 3.4 ± 1.9, and these tumours did not differ in pathology, size, depth from the pleural surface or metabolic activity. CONCLUSIONS NIR fluorescence imaging could safely identify pulmonary neoplasms after the systemic injection of ICG. In addition, low-dose ICG is sufficient for NIR fluorescence imaging of pulmonary neoplasms. However, because the passive accumulation of ICG could not be used to discriminate tumours with inflammation, tumour-targeted fluorescence should be developed to solve this problem in the future.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu Hua Quan
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Seoul, Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeonho Choi
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| | - Beop-Min Kim
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Rosenthal EL, Warram JM, Bland KI, Zinn KR. The status of contemporary image-guided modalities in oncologic surgery. Ann Surg 2015; 261:46-55. [PMID: 25599326 DOI: 10.1097/sla.0000000000000622] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the current trends in optical imaging to guide oncologic surgery. BACKGROUND Surgical resection remains the cornerstone of therapy for patients with early stage solid malignancies and more than half of all patients with cancer undergo surgery each year. The technical ability of the surgeon to obtain clear surgical margins at the initial resection remains crucial to improve overall survival and long-term morbidity. Current resection techniques are largely based on subjective and subtle changes associated with tissue distortion by invasive cancer. As a result, positive surgical margins occur in a significant portion of tumor resections, which is directly correlated with a poor outcome. METHODS A comprehensive review of studies evaluating optical imaging techniques is performed. RESULTS A variety of cancer imaging techniques have been adapted or developed for intraoperative surgical guidance that have been shown to improve functional and oncologic outcomes in randomized clinical trials. There are also a large number of novel, cancer-specific contrast agents that are in early stage clinical trials and preclinical development that demonstrate significant promise to improve real-time detection of subclinical cancer in the operative setting. CONCLUSIONS There has been an explosion of intraoperative imaging techniques that will become more widespread in the next decade.
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Affiliation(s)
- Eben L Rosenthal
- *Departments of Surgery and †Radiology, The University of Alabama at Birmingham, Birmingham, AL
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Near-Infrared Fluorescence Imaging with Intraoperative Administration of Indocyanine Green for Robotic Partial Nephrectomy. Curr Urol Rep 2015; 16:20. [DOI: 10.1007/s11934-015-0495-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Do Statin Medications Impact Renal Functional or Oncologic Outcomes for Robot-Assisted Partial Nephrectomy? J Endourol 2014; 28:1308-12. [DOI: 10.1089/end.2014.0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Current Applications of Near-infrared Fluorescence Imaging in Robotic Urologic Surgery: A Systematic Review and Critical Analysis of the Literature. Urology 2014; 84:751-9. [DOI: 10.1016/j.urology.2014.05.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/09/2014] [Accepted: 05/28/2014] [Indexed: 11/21/2022]
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Krane LS, Hemal AK. Emerging technologies to improve techniques and outcomes of robotic partial nephrectomy: striving toward the pentafecta. Urol Clin North Am 2014; 41:511-9. [PMID: 25306163 DOI: 10.1016/j.ucl.2014.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The technique of robotic partial nephrectomy continues to evolve, but the goals remain the same. Achievement of pentafecta outcomes is difficult to obtain; however, surgeons should continue to strive for this standard of excellence. The future continues to be bright for patients and surgeons alike in continuing to perform robot-assisted partial nephrectomy.
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Affiliation(s)
- L Spencer Krane
- Department of Urology, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Abstract
PURPOSE OF REVIEW The development of the robotic systems has made surgery an increasingly technology-driven field. Since the introduction of the first robotic platform in 2005, surgical practice in South Korea has also been caught up in the global robotic revolution. Consequently, a market focused on improving the robotic systems was created and Korea has emerged as one of its frontrunners. This article reviews the Korean experience in developing various robotic technologies and then Korea's most recent contributions to the development of new technologies in robotic surgery. RECENT FINDINGS The goal of new technologies in the field of robotic surgery has been to improve on the current platforms by eliminating their disadvantages. The pressing goal is to develop a platform that is less bulky, more ergonomic, and capable of providing force feedback to the surgeon. In Korea, the Lapabot and two new robotic systems for single-port laparoscopic surgery are the most recent advances that have been reported. SUMMARY Robotic surgery is rapidly evolving and Korea has stayed in the forefront of its development. These new advancements in technology will eventually produce better robotic platforms that will greatly improve the manner in which surgical care is delivered.
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Abstract
PURPOSE OF REVIEW To review optical imaging technologies in urologic surgery aimed to facilitate intraoperative imaging and tissue interrogation. RECENT FINDINGS Emerging new optical imaging technologies can be integrated in the operating room environment during minimally invasive and open surgery. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. SUMMARY Optical imaging technologies that have reached the clinical arena in urologic surgery were reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy.
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The Role of Indocyanine Green for Robotic Partial Nephrectomy: Early Results, Limitations and Future Directions. ROBOTICS 2014. [DOI: 10.3390/robotics3030281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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McClintock TR, Bjurlin MA, Wysock JS, Borofsky MS, Marien TP, Okoro C, Stifelman MD. Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? Urology 2014; 84:327-32. [PMID: 24909960 DOI: 10.1016/j.urology.2014.02.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/07/2013] [Accepted: 02/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near-infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. METHODS From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (eGFR), functional kidney status, age, sex, body mass index, and American Society of Anesthesiologists score, who underwent RPN without selective clamping and NIRF imaging. RESULTS In matched-pair analysis, selective clamping with NIRF was associated with superior kidney function at discharge, as demonstrated by postoperative eGFR (78.2 vs 68.5 mL/min/1.73 m(2); P = .04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m(2); P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] = .07; P[absolute reduction of eGFR] = .10; and P[percent change in eGFR] = .07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. CONCLUSION Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective arterial clamping and NIRF imaging. With this effect attenuated at later follow-up, randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this technology.
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Affiliation(s)
- Tyler R McClintock
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - James S Wysock
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Michael S Borofsky
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Tracy P Marien
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Chinonyerem Okoro
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Department of Urology, New York University Langone Medical Center, New York, NY.
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Fluorescence-enhanced robotic radical cystectomy using unconjugated indocyanine green for pelvic lymphangiography, tumor marking, and mesenteric angiography: the initial clinical experience. Urology 2014; 83:824-9. [PMID: 24680450 DOI: 10.1016/j.urology.2013.11.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/27/2013] [Accepted: 11/01/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the initial feasibility of fluorescence-enhanced robotic radical cystectomy (FERRC) using real-time cystoscopic injection of unconjugated indocyanine green (ICG) for tumor marking and identification of sentinel lymphatic drainage with additional intravenous injection for mesenteric angiography. METHODS Ten patients with clinically localized high-grade bladder cancer underwent FERRC. Before robot docking, rigid cystoscopy was performed, during which a 2.5-mg/mL ICG solution was injected in the bladder submucosa and detrusor circumferentially around the tumor. After robot docking, parameters describing the time course of tissue fluorescence and pelvic lymphangiography were systematically recorded. Lymphatic packets containing fluorescent lymph nodes were considered the sentinel drainage. Eight patients underwent intracorporeal ileal conduit urinary diversion, during which an additional 2-mL ICG solution was given intravenously for mesenteric angiography, allowing maximal preservation of bowel vascularity to the conduit and remaining bowel segments. RESULTS Bladder tumor marking and identification of sentinel drainage were achieved in 9 of 10 (90%) patients. The area of bladder tumor was identified at a median of 15 minutes after injection, whereas sentinel drainage was visualized at a median of 30 minutes. Mesenteric angiography was successful in 8 of 8 (100%) patients at a median time of <1 minutes after intravenous injection and enabled identification of bowel arcades before intracorporeal bowel stapling. CONCLUSION FERRC using combined cystoscopic and intravenous injection of ICG is safe and feasible. FERRC allows for reliable bladder tumor marking, identification of sentinel lymphatic drainage, and identification of mesenteric vasculature in most patients.
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Manny TB, Hemal AK. Reply: To PMID 24680451. Urology 2014; 83:829-30. [PMID: 24680452 DOI: 10.1016/j.urology.2013.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ted B Manny
- Department of Urology, Wake Forest University, Winston-Salem, NC
| | - Ashok K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC
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