Indocyanine green use in Urology

Area of Science:

• Urology
• Surgical Innovation
• Medical Imaging

Background:

• Indocyanine green (ICG) is increasingly utilized in urology, particularly with advancements in minimally invasive surgery.
• Its role in guiding excision, reconstruction, and highlighting anatomical structures is expanding, though oncologic guidance remains under investigation.
• This study explores the application and benefits of ICG fluorescence in various urologic procedures.

Purpose of the Study:

• To evaluate the utility and effectiveness of Indocyanine green (ICG) fluorescence guidance in a range of urologic operations.
• To assess the impact of ICG on identifying key anatomical and pathological structures during minimally invasive surgery.
• To compare postoperative complication rates in procedures performed with and without ICG guidance.

Main Methods:

• Experience from 37 cases using ICG fluorescence guidance with 3D laparoscopy and Da Vinci X robot's FireFly® mode.
• Procedures included: radical prostatectomy with pelvic lymphadenectomy, intracorporeal ileal neobladder reconstruction, fistula repair, partial nephrectomy, and pyeloplasty.
• Barnard's test compared postoperative complications (digestive fistula, ureteral stricture) in neobladder reconstructions with (27 cases) versus without (28 cases) ICG guidance.

Main Results:

• ICG fluorescence precisely identified ischemic and vascularized tissues (vaginal wall, ureteral ends, ileal loops), optimizing partial nephrectomy and pyeloplasty.
• A crucial lymph node was identified during radical prostatectomy that might have been missed otherwise.
• No complications related to ICG usage were observed, and the complication rate for neobladder reconstruction was significantly lower (p=0.002716) when ICG was used.

Conclusions:

• ICG fluorescence effectively aids in identifying critical anatomical and pathological structures in laparoscopic and robotic urologic surgeries for malignant and benign conditions.
• The use of ICG may positively influence perioperative complications.
• Potential benefits extend to improved oncologic and functional postoperative outcomes in urologic procedures.