Laparoscopic partial adrenalectomy using near-infrared imaging: the initial experience.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Medical Imaging

Background:

• Laparoscopic partial adrenalectomy (LPA) is a key surgical technique for adrenal tumors.
• Intraoperative visualization is crucial for successful LPA, aiming to preserve adrenal function.
• Indocyanine green (ICG) dye with near-infrared fluorescence (NIRF) imaging offers advanced visualization capabilities.

Purpose of the Study:

• To evaluate the initial clinical experience and feasibility of LPA using ICG dye with NIRF imaging.
• To assess the safety and efficacy of this technique in adrenal tumor resection.
• To determine the utility of ICG/NIRF imaging in differentiating adrenal lesions.

Main Methods:

• Eight patients underwent transperitoneal LPA using ICG dye and NIRF imaging.
• A dose of 5 mg ICG was administered intravenously.
• Tumor resection was guided by NIRF imaging and white light visualization to ensure complete excision and tissue sparing.

Main Results:

• All eight patients (seven unilateral, one bilateral) underwent successful LPA with negative margins.
• The median tumor size was 43 mm.
• ICG/NIRF demonstrated varying fluorescence: hypofluorescence for Cushing's syndrome, aldosteronoma, and cysts; isofluorescence for pheochromocytoma; and hyperfluorescence for angiomyolipoma.

Conclusions:

• Laparoscopic partial adrenalectomy with ICG/NIRF imaging is a safe and feasible approach.
• This technology can potentially improve surgical precision by identifying vascular structures and aiding in margin assessment.
• ICG/NIRF may assist in intraoperative differentiation of adrenal tumor types.