Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery
Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery
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DOI：
10.3389/fped.2020.00314
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发表时间：
2020-06-17
影响因子：
2.6
通讯作者：
Escolino, Maria
中科院分区：
文献类型：
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作者：
Esposito, Ciro;Settimi, Alessandro;Escolino, Maria
背景：吲哚菁绿色（ICG）引导的近红外荧光（NIRF）最近已被用于儿科微创手术（MIS）。本研究旨在报告我们在儿科腹腔镜检查和机器人技术中使用ICG引导的NIRF的经验，并评估其在不同儿科病理中的有用性和应用技术。方法：在24个月的时间内，在小儿外科的一个科室完成的76例腹腔镜和/或机器人手术中采用ICG技术（2018年1月至2020年）：40（37例腹腔镜，3例机器人）左侧精索静脉曲张切除术，术中淋巴造影; 13例（10例腹腔镜手术，3例机器人手术）肾脏手术：7例部分肾切除术，3例肾切除术和3例肾囊肿去顶术; 12例腹腔镜胆囊切除术; 5例机器人肿瘤切除术; 3例腹腔镜腹部淋巴瘤切除术; 3例胸腔镜手术：2例肺叶切除术和1例疑似淋巴瘤的淋巴结活检。ICG溶液在所有适应症中均通过外周静脉给药，但精索静脉曲张和淋巴瘤除外，其中ICG溶液分别注射到睾丸体或靶器官中。关于给药时间，ICG溶液在所有适应症中均在术中给药，但胆囊切除术除外，其中ICG注射在术前15-18小时进行。结果：无中转开腹或腹腔镜手术。未报告ICG的不良反应和过敏反应或其他术后并发症。结论：根据我们2年的经验，我们认为ICG引导的NIRF在儿科MIS中是一种非常有用的工具，可以执行真正的图像引导手术，从而更容易识别解剖结构，并在困难病例中更容易执行手术。在小儿外科中最常见的应用包括精索静脉曲张修复术、困难的胆囊切除术、肾部分切除术、淋巴瘤和肿瘤切除术，但很快就会发现进一步的适应症。ICG增强荧光在技术上易于应用，对患者安全，报告对产品无不良反应。主要的限制是在腹腔镜手术中应用ICG引导的NIRF所需的特定设备，这在所有中心都不可用，而ICG系统Firefly（R）已经集成到机器人平台中。
Background:Indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) has been recently adopted in pediatric minimally invasive surgery (MIS). This study aimed to report our experience with ICG-guided NIRF in pediatric laparoscopy and robotics and evaluate its usefulness and technique of application in different pediatric pathologies. Methods:ICG technology was adopted in 76 laparoscopic and/or robotic procedures accomplished in a single division of pediatric surgery over a 24-month period (January 2018-2020): 40 (37 laparoscopic, three robotic) left varicocelectomies with intra-operative lymphography; 13 (10 laparoscopic, three robotic) renal procedures: seven partial nephrectomies, three nephrectomies, and three renal cyst deroofings; 12 laparoscopic cholecystectomies; five robotic tumor excisions; three laparoscopic abdominal lymphoma excisions; three thoracoscopic procedures: two lobectomies and one lymph node biopsy for suspected lymphoma. The ICG solution was administered into a peripheral vein in all indications except for varicocele and lymphoma in which it was, respectively, injected into the testis body or the target organ. Regarding the timing of the administration, the ICG solution was administered intra-operatively in all indications except for cholecystectomy in which the ICG injection was performed 15-18 h before surgery. Results:No conversions to open or laparoscopy occurred. No adverse and allergic reactions to ICG or other postoperative complications were reported. Conclusions:Based upon our 2 year experience, we believe that ICG-guided NIRF is a very useful tool in pediatric MIS to perform a true imaged-guided surgery, allowing an easier identification of anatomic structures and an easier surgical performance in difficult cases. The most common applications in pediatric surgery include varicocele repair, difficult cholecystectomy, partial nephrectomy, lymphoma, and tumors excision but further indications will be soon discovered. ICG-enhanced fluorescence was technically easy to apply and safe for the patient reporting no adverse reactions to the product. The main limitation is represented by the specific equipment needed to apply ICG-guided NIRF in laparoscopic procedures, that is not available in all centers whereas the ICG system Firefly (R) is already integrated into the robotic platform.