Robot-Assisted Laparoscopic Partial Adrenalectomy Utilizing Intraoperative Indocyanine Green Near-Infrared
Nae Takizawa1, Haruyuki Ohsugi1, Monta Inoue1
1Department of Urology and Andrology Kansai Medical University Hospital Osaka Japan.
Introduction:
Indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging facilitates pheochromocytoma identification during adrenal surgery.
Case Presentation:
We report a 21-year-old woman with multiple endocrine neoplasia type 2A and bilateral adrenal tumors who underwent ICG-NIRF-guided, robot-assisted partial adrenalectomy for pheochromocytomas. Following left adrenalectomy, partial right adrenalectomy was performed using intraoperative ICG-NIRF imaging. After intravenous administration of 2.5 mg ICG, the normal adrenal cortex exhibited strong fluorescence, whereas the pheochromocytoma showed no fluorescence. However, fluorescence from the overlying normal adrenal cortex partially obscured the tumor, which was identified by intraoperative ultrasonography. Combined ICG-NIRF imaging and ultrasonography enabled maximal preservation of functional adrenal cortex. Postoperatively, metanephrine and normetanephrine levels normalized, and hydrocortisone was tapered and discontinued.
Conclusion:
ICG-NIRF is a useful adjunct for cortical visualization; however, multimodal guidance is essential for precise tumor delineation during cortical-sparing adrenalectomy.
