Mangano Mario S, De Gobbi Alberto, Beniamin Francesco, Lamon Claudio, Ciaccia Matteo, Maccatrozzo Luigino
Urology Unit, Azienda U.L.S.S. n 2 Marca Trevigiana, Treviso Hospital, Treviso - Italy.
Urologia. 2018 Feb;85(1):29-31. doi: 10.5301/uj.5000244. Epub 2018 Feb 19.
Indocyanine green (ICG) is a fluorescent molecule that provokes detectable photon emission. The use of ICG with near-infrared (NIR) imaging system (Akorn, Lake Forest, IL) has been described during robotic partial nephrectomy (RAPN) as an adjunctive means of identifying renal artery and parenchymal perfusion. We propose the use of the ICG with NIR fluorescence during laparoscopic robot-assisted radical prostatectomy (RARP), to identify the benchmark artery improving the preservation of neurovascular bundle and to improve the visualization of the vascularization and then the hemostasis.
From April 2015 to February 2016, 62 patients underwent to RARP in our Urology Unit. In 26 consecutive patients, in the attempt to have a better visualization of neurovascular bundles, we used to inject ICG during the procedure. We evaluated the percentage of identification of neurovascular bundles using NIR fluorescence. Then, we evaluated complications related to injection of ICG and operative time differences between RARP with and without ICG injection performed by the same surgeons.
We identified prostatic arteries and neurovascular bundles using NIR fluorescence technology in all patients (100%). There was not any increase in the operative time compared with RARP without ICG injection performed by the same surgeons. Complications related to injection of ICG did not occurred.
In our experience, even if on a limited number of patients, the application of ICG with NIR fluorescence during RARP is helpful to identify the benchmark artery of neurovascular bundle.
吲哚菁绿（ICG）是一种能引发可检测光子发射的荧光分子。吲哚菁绿与近红外（NIR）成像系统（Akorn，伊利诺伊州莱克福里斯特）在机器人辅助肾部分切除术（RAPN）中已被用于识别肾动脉和实质灌注，作为一种辅助手段。我们建议在腹腔镜机器人辅助根治性前列腺切除术（RARP）中使用吲哚菁绿与近红外荧光，以识别基准动脉，改善神经血管束的保留，并改善血管化的可视化进而改善止血效果。
2015年4月至2016年2月，62例患者在我们泌尿外科接受了RARP手术。在连续26例患者中，为了更好地可视化神经血管束，我们在手术过程中注射了吲哚菁绿。我们使用近红外荧光评估神经血管束的识别率。然后，我们评估了与吲哚菁绿注射相关的并发症以及同一组外科医生进行的注射吲哚菁绿和未注射吲哚菁绿的RARP手术之间的手术时间差异。
我们使用近红外荧光技术在所有患者（100%）中识别出了前列腺动脉和神经血管束。与同一组外科医生进行的未注射吲哚菁绿的RARP手术相比，手术时间没有任何增加。与吲哚菁绿注射相关的并发症未发生。
根据我们的经验，即使患者数量有限，在RARP手术中应用吲哚菁绿与近红外荧光有助于识别神经血管束的基准动脉。
