Advertisement

Current Urology Reports

, 16:20 | Cite as

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

  • Marc A. Bjurlin
  • Tyler R. McClintock
  • Michael D. Stifelman
New Imaging Techniques (A Rastinehad and S Rais-Bahrami, Section Editors)
Part of the following topical collections:
  1. Topical Collection on New Imaging Techniques

Abstract

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

Keywords

Near-infrared fluorescence imaging Indocyanine green Robotic partial nephrectomy Selective arterial clamping Tumor localization 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Marc A. Bjurlin and Dr. Tyler R. McClintock each declare no potential conflicts of interest.

Dr. Michael D. Stifelman is a consultant for Vascular Technology Inc. and Surgiquest and a lecturer/ownership of Intuitive Surgical, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclosures

MAB: none

TRM: none

MDS: Consultant VTI, Consultant Surgiquest, Lecturer/Ownership Intuitive Surgical, Inc.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Binder J, Brautigam R, Jonas D, Bentas W. Robotic surgery in urology: fact or fantasy? BJU Int. 2004;94:1183–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Atug F, Castle EP, Woods M, Davis R, Thomas R. Robotics in urologic surgery: an evolving new technology. Int J Urol. 2006;13:857–63.CrossRefPubMedGoogle Scholar
  3. 3.
    van den Berg NS, van Leeuwen FW, van der Poel HG. Fluorescence guidance in urologic surgery. Curr Opin Urol. 2012;22:109–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Baker KJ. Binding of sulfobromophthalein (BSP) sodium and indocyanine green (ICG) by plasma alpha-1 lipoproteins. Proc Soc Exp Biol Med. 1966;122:957–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol. 2000;45:15–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Tobis S, Knopf JK, Silvers CR, Marshall J, Cardin A, Wood RW, et al. Near infrared fluorescence imaging after intravenous indocyanine green: initial clinical experience with open partial nephrectomy for renal cortical tumors. Urology. 2012;79:958–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Hope-Ross M, Yannuzzi LA, Gragoudas ES, Guyer DR, Slakter JS, Sorenson JA, et al. Adverse reactions due to indocyanine green. Ophthalmology. 1994;101:529–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Ebert B, Riefke B, Sukowski U, Licha K. Cyanine dyes as contrast agents for near-infrared imaging in vivo: acute tolerance, pharmacokinetics, and fluorescence imaging. J Biomed Opt. 2011;16:066003.CrossRefPubMedGoogle Scholar
  9. 9.
    Ott P, Bass L, Keiding S. The kinetics of continuously infused indocyanine green in the pig. J Pharmacokinet Biopharm. 1996;24:19–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Shinohara H, Tanaka A, Kitai T, Yanabu N, Inomoto T, Satoh S, et al. Direct measurement of hepatic indocyanine green clearance with near-infrared spectroscopy: separate evaluation of uptake and removal. Hepatology. 1996;23:137–44.CrossRefPubMedGoogle Scholar
  11. 11.••
    Bjurlin MA, Gan M, McClintock TR, Volpe A, Borofsky MS, Mottrie A, et al. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol. 2014;65:793–801. Clinical study demonstrating the initial surgical technique for NIRF imaging with ICG to facilitate selective arterial clamping along with additional applications in robotic urinary reconstruction. Short term outcomes demonstrated a median percent change in eGFR of 6.3%.CrossRefPubMedGoogle Scholar
  12. 12.•
    McClintock TR, Bjurlin MA, Wysock JS, Borofsky MS, Marien TP, Okoro C, et al. Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? Urology. 2014;84:327–34. Matched-pair analysis of robotic partial nephrectomy with and without selective arterial clamping with NIRF and ICG. Selective clamping was associated with superior kidney function at discharge but this statistical difference was not observed at 3 months follow-up.CrossRefPubMedGoogle Scholar
  13. 13.
    Piwkowski C, Gabryel P, Gasiorowski L, Zielinski P, Murawa D, Roszak M, et al. Indocyanine green fluorescence in the assessment of the quality of the pedicled intercostal muscle flap: a pilot study. Eur J Cardiothorac Surg. 2013;44(1):e77–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Pacheco PE, Hill SM, Henriques SM, Paulsen JK, Anderson RC. The novel use of intraoperative laser-induced fluorescence of indocyanine green tissue angiography for evaluation of the gastric conduit in esophageal reconstructive surgery. Am J Surg. 2013;205:349–52. discussion 352–343.CrossRefPubMedGoogle Scholar
  15. 15.
    Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, et al. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc. 2013;27(8):3003–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Tobis S, Knopf J, Silvers C, Yao J, Rashid H, Wu G, et al. Near infrared fluorescence imaging with robotic assisted laparoscopic partial nephrectomy: initial clinical experience for renal cortical tumors. J Urol. 2011;186:47–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Tobis S, Knopf JK, Silvers C, Messing E, Yao J, Rashid H, et al. Robot-assisted and laparoscopic partial nephrectomy with near infrared fluorescence imaging. J Endourol. 2012;26:797–802.CrossRefPubMedGoogle Scholar
  18. 18.
    Krane LS, Manny TB, Hemal AK. Is near infrared fluorescence imaging using indocyanine green dye useful in robotic partial nephrectomy: a prospective comparative study of 94 patients. Urology. 2012;80:110–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Golijanin DJMJ, Cardin A, Singer EA, Wood RW, Reeder JE, et al. Bilitranslocase (BTL) is immunolocalised in proximal and distal renal tubules and absent in renal cortical tumors accurately corresponding to intraoperative near infrared fluorescence (NIRF) expression of renal cortical tumors using intravenous INDOCYANINE GREEN (ICG). J Urol. 2008;179:137.CrossRefGoogle Scholar
  20. 20.
    Manny T, Krane LS, Hemal AK. Indocyanine green cannot predict malignancy in partial nephrectomy: histopathologic correlation with fluorescence pattern in 100 patients. J Endourol 2013;27:918–21.Google Scholar
  21. 21.
    Phillips BT, Lanier ST, Conkling N, Wang ED, Dagum AB, Ganz JC, et al. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg. 2012;129:778e–88.CrossRefPubMedGoogle Scholar
  22. 22.•
    Borofsky MS, Gill IS, Hemal AK, Marien TP, Jayaratna I, Krane LS, et al. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy. BJU Int 2013;111:604–10. First study to demonstrate the improvement in short term kidney function of robotic partial nephrectomy with selective arterial clamping using NIRF and ICG with only a 1.8% loss in eGFR compared to 14.9% in the main artery clamp cohort.Google Scholar
  23. 23.
    Feliciano J, Stifelman M. Robotic retroperitoneal partial nephrectomy: a four-arm approach. JSLS. 2012;16:208–11.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Dulabon LM, Kaouk JH, Haber GP, Berkman DS, Rogers CG, Petros F, et al. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol. 2011;59:325–30.CrossRefPubMedGoogle Scholar
  25. 25.
    Mitsui Y, Shiina H, Arichi N, et al. Indocyanine green (ICG)-based fluorescence navigation system for discrimination of kidney cancer from normal parenchyma: application during partial nephrectomy. Int Urol Nephrol. 2012;44:753.CrossRefPubMedGoogle Scholar
  26. 26.
    Angell JE, Khemees TA, Abaza R. Optimization of near infrared fluorescence tumor localization during robotic partial nephrectomy. J Urol. 2013;190:1668–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Harke N, Schoen G, Schiefelbein F, et al. Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: a single-surgeon matched-pair study. World J Urol. 2014;32:1259.CrossRefPubMedGoogle Scholar
  28. 28.
    Chapman D, Moore R, Klarenbach S, Braam B. Residual renal function after partial or radical nephrectomy for renal cell carcinoma. Can Urol Assoc J. 2010;4:337–43.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Marc A. Bjurlin
    • 1
  • Tyler R. McClintock
    • 2
  • Michael D. Stifelman
    • 3
  1. 1.Division of Urology, Department of SurgerySBH Health SystemBronxUSA
  2. 2.Division of Urology, Department of Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of UrologyNew York University, Langone Medical CenterNew YorkUSA

Personalised recommendations