Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336, Munich, Germany.
Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistr. 11, 80337, Munich, Germany.
Surg Endosc. 2020 May;34(5):2050-2055. doi: 10.1007/s00464-019-06985-7. Epub 2019 Jul 24.
Indocyanine green (ICG) fluorescence imaging represents an emerging technology that facilitates the assessment of tissue vascularity, tissue distinction, and tumor localization during surgery. The aim of this study was to investigate the potential role of ICG imaging during laparoscopic partial adrenalectomy.
Indocyanine fluorescence imaging was carried out during laparoscopic partial adrenalectomy for bilateral pheochromocytoma and bilateral Cushing's syndrome. A first bolus of 5 mg ICG was applied intravenously upon exposure of the retroperitoneal plane to identify the adrenal borders. The fluorescence was visualized using a Storz NIR/ICG endoscopic system. As the camera of this system detects NIR light as a blue signal, the well-vascularized adrenal tissue was expected to show a strong fluorescence in the blue color channel in contrast to the surrounding adipose tissue. Following partial adrenalectomy, a second bolus of 5 mg ICG was applied intravenously to evaluate the vascularity of the remaining adrenal tissue.
We investigated six adrenal glands from three patients undergoing bilateral partial adrenalectomy. The indication for surgery was pheochromocytoma in two patients and Cushing's syndrome with bilateral adenomas in one patient. Regarding left adrenalectomies, ICG imaging was helpful in visualizing the adrenal borders and the adrenal vein. Further, it facilitated the identification of the hypofluorescent pheochromocytoma and to resect the entire tumor. On the right side, due to the more apparent anatomy, ICG imaging did not contribute to the conduct of the operation. Four adrenal remnants showed a strong vascularization and two remnants were only reasonably vascularized.
ICG fluorescence may be helpful in guiding partial adrenalectomy and assessing the vascularity of remaining adrenal tissue.
吲哚菁绿（ICG）荧光成像是一种新兴技术，可在手术期间促进组织血管生成、组织区分和肿瘤定位的评估。本研究旨在探讨吲哚菁绿成像在腹腔镜肾上腺部分切除术的应用潜力。
对双侧嗜铬细胞瘤和双侧库欣综合征患者进行腹腔镜肾上腺部分切除术时，应用吲哚菁绿荧光成像。在腹膜后平面暴露时，静脉内给予 5mgICG 首剂，以识别肾上腺边界。使用 Storz NIR/ICG 内窥镜系统观察荧光。由于该系统的摄像头将近红外光检测为蓝色信号，因此预计富含血管的肾上腺组织在蓝色颜色通道中显示强烈荧光，与周围脂肪组织形成对比。行部分肾上腺切除术后，静脉内给予 5mgICG 第二剂，以评估剩余肾上腺组织的血管生成情况。
我们研究了 3 名患者的 6 个肾上腺，这些患者均行双侧肾上腺部分切除术。2 例患者的手术指征为嗜铬细胞瘤，1 例患者为双侧腺瘤所致库欣综合征。对于左侧肾上腺切除术，ICG 成像有助于可视化肾上腺边界和肾上腺静脉。此外，它有助于识别荧光较弱的嗜铬细胞瘤并切除整个肿瘤。在右侧，由于解剖结构更为明显，ICG 成像并未有助于手术进行。4 个肾上腺残部显示出强烈的血管化，2 个残部仅有适度的血管化。
吲哚菁绿荧光可能有助于指导肾上腺部分切除术和评估剩余肾上腺组织的血管生成情况。
