Applications in Adrenal Surgery
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Minimally invasive adrenalectomy has become the standard of care for the treatment of adrenal tumors. A successful adrenalectomy requires the identification of the adrenal tumor in the retroperitoneal fat as well as emphasizing the correct dissection plane throughout the dissection. Although laparoscopic ultrasound has been increasingly used for this purpose, it heavily relies on a good contact between the ultrasound probe and the retroperitoneal tissues. This can limit its usefulness in patients with difficult anatomy. Indocyanine green (ICG) fluorescence imaging has recently been described as an intraoperative tool that does not require tissue contact. It involves the intravenous administration of ICG intraoperatively and the use of near-infrared fluorescence systems to visualize the resulting fluorescence. Such systems are available for both laparoscopic and robotic platforms. This chapter describes the use of this technology in a robotic platform and discusses its strengths and limitations based on a literature review and institutional expertise.
KeywordsRobotic adrenalectomy ICG Indocyanine green Fluorescence imaging Literature review
Video clip describing the performance of indocyanine green-guided robotic lateral transabdominal adrenalectomy for a left-sided adrenal lesion (MP4 584634 kb)