Near-Infrared fluorescence imaging using indocyanine green (ICG): Emerging applications in pediatric urology
Near-Infrared fluorescence imaging using indocyanine green (ICG): Emerging applications in pediatric urology
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DOI：
10.1016/j.jpurol.2020.07.008
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发表时间：
2020-10-01
影响因子：
2
通讯作者：
Escolino, Maria
中科院分区：
文献类型：
--
作者：
Esposito, Ciro;Coppola, Vincenzo;Escolino, Maria
背景吲哚菁绿色（ICG）近红外荧光（NIRF）成像技术近年来被应用于小儿微创手术（MIS）中，以改善术中、术后的并发症。本研究旨在报告我们在使用腹腔镜和机器人技术的小儿泌尿外科中使用ICG技术的初步经验。研究设计ICG技术在57例腹腔镜或机器人泌尿外科手术中使用在我们的单位进行了超过24个月的时间：41（38腹腔镜3机器人）左精索静脉曲张修复术与术中淋巴造影和16个肾脏程序（12腹腔镜4机器人），包括9个部分肾切除术，3肾切除术和4肾囊肿deroofings.ResultsICG溶液静脉注射在肾脏程序或睾丸体的情况下精索静脉曲张修复。关于给药时间，所有病例均在术中进行ICG注射，并允许在30 - 60秒内观察解剖结构。在所有适应症中，ICG的剂量为0.3 mg/mL/kg。所有手术均通过腹腔镜或机器人完成，无转换。没有不良反应和过敏反应ICG和其他并发症发生postoperatives.DiscussionThis本文介绍了第一次在小儿泌尿科，ICG引导的近红外成像可能有助于腹腔镜和机器人程序。在精索静脉曲张修复的情况下，ICG增强荧光允许执行保留血管的程序，避免术后鞘膜积液的风险。在肾部分切除术的情况下，ICG引导的NIRF有助于可视化无功能部分的血管化，识别两个部分之间的解剖平面（图1），并检查切除无功能极后残留实质的灌注。在肾囊肿去顶的情况下，ICG引导的NIRF有助于识别无血管的囊肿圆顶并指导其切除。没有真实的好处，使用ICG增强荧光观察nephrotectomy.ConclusionOur初步经验证实了ICG技术在小儿泌尿外科的安全性和有效性，并强调其潜在的优势，在接受腹腔镜手术或机器人泌尿外科手术的患者的连续手术技术。使用NIRF也具有成本效益，因为除了ICG染料（每瓶40欧元）外，不需要额外的成本。在小儿泌尿外科中最常见和有用的应用包括精索静脉曲张修补术、肾部分切除术和肾囊肿去顶术。主要的限制是腹腔镜检查所需的特定设备，并非所有中心都有，而机器人配备了NIRF的Firefly（R）软件。
BackgroundNear-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) has been recently adopted in pediatric minimally invasive surgery (MIS) in order to improve intra-operative visualization of anatomic structures and facilitate surgery.ObjectiveThis study aimed to report our preliminary experience using ICG technology in pediatric urology using laparoscopy and robotics.Study designICG technology was adopted in 57 laparoscopic or robotic urological procedures performed in our unit over a 24-month period: 41 (38 laparoscopic 3 robotic) left varicocele repairs with intra-operative lymphography and 16 renal procedures (12 laparoscopic 4 robotic) including 9 partial nephrectomies, 3 nephrectomies and 4 renal cyst deroofings.ResultsThe ICG solution was injected intravenously in renal procedures or into the testis body in case of varicocele repair. Regarding the timing of the administration, the ICG injection was performed intraoperatively in all cases and allowed the visualization of the anatomic structures in a matter of 30-60 s. The dosage of ICG was 0.3 mg/mL/kg in all indications. All procedures were completed laparoscopically or robotically without conversions. No adverse and allergic reactions to ICG and other complications occurred postoperatively.DiscussionThis paper describes for the first time in pediatric urology that ICG-guided NIRF imaging may be helpful in laparoscopic and robotic procedures. In case of varicocele repair, ICG-enhanced fluorescence allowed to perform a lymphatic-sparing procedure and avoid the risk of postoperative hydrocele. In case of partial nephrectomy, ICG-guided NIRF was helpful to visualize the vascularization of the non-functioning moiety, identify the dissection plane between the two moieties (Fig. 1) and check the perfusion of the residual parenchyma after resection of the non-functioning pole. In case of renal cyst deroofing, ICG-guided NIRF aided to identify the avascular cyst dome and to guide its resection. No real benefits of using ICG-enhanced fluorescence were observed during nephrectomy.ConclusionOur preliminary experience confirmed the safety and efficacy of ICG technology in pediatric urology and highlighted its potential advantages as adjunctive surgical technology in patients undergoing laparoscopic or robotic urological procedures. Use of NIRF was also cost-effective as no added costs were required except for the ICG dye (cost 40 eur per bottle). The most common and useful applications in pediatric urology included varicocele repair, partial nephrectomy ad renal cyst deroofing. The main limitation is the specific equipment needed in laparoscopy, that is not available in all centers whereas the robot is equipped with the Firefly (R) software for NIRF.