Juan Manuel Martos Martínez, Mercedes Rubio-Manzanares Dorado, Verónica Pino Díaz, Javier Padillo Ruíz
Endocrine Surgery Unit, General and Digestive Surgery Department, Virgen del Rocio University Hospital, Avda. Manuel Siurot S/N, 41013, Seville, Spain.
Updates Surg. 2024 Dec;76(8):2851-2862. doi: 10.1007/s13304-024-01966-5. Epub 2024 Aug 27.
Indocyanine green imaging (ICG) is an expansion technology that can contribute to the development of demanding techniques such as cortical-sparing adrenalectomy (CSA). The aim of this study was to determine in which cases CSA should be performed and when total adrenalectomy should be performed instead based on ICG fluorescence. Here, we present our experience through a series of cases and videos.
Prospective and descriptive study on patients with surgical adrenal lesions who were proposed for CSA using ICG with near-infrared fluorescence imaging in our center. A first bolus of 6,25 mg ICG was administered intravenously upon exposure of the retroperitoneal plane. Fluorescence was visualized using a Storz NIR/ICG endoscopic system.
Seven patients were proposed for CSA. After the application of ICG, a change in attitude was carried out in 71.4% of the cases (five of seven). In the two patients in whom CSA could be performed, the adrenal remnants were functional, and the resection margins of the surgical specimens were free of disease. The reasons why partial adrenalectomy could not be completed, and a total adrenalectomy was decided instead were the presence of a tumor located very close to the adrenal vein that prevented a correct remnant volume (n = 4) and one case of isofluorescent tumor with the adrenal parenchyma.
ICG fluorescence guidance could help in the decision making to select patients intraoperatively for successful cortical preservation.
吲哚菁绿成像（ICG）是一种扩展技术，有助于诸如保留皮质肾上腺切除术（CSA）等复杂技术的发展。本研究的目的是根据ICG荧光确定哪些病例应进行CSA，哪些病例应改为进行全肾上腺切除术。在此，我们通过一系列病例和视频展示我们的经验。
对在我们中心拟行使用ICG和近红外荧光成像的CSA的肾上腺手术病变患者进行前瞻性描述性研究。在暴露腹膜后平面时静脉注射首剂6.25mg ICG。使用史托斯NIR/ICG内镜系统观察荧光。
7例患者拟行CSA。应用ICG后，71.4%的病例（7例中的5例）改变了手术方式。在2例可行CSA的患者中，肾上腺残余有功能，手术标本的切缘无病变。无法完成部分肾上腺切除术而决定行全肾上腺切除术的原因是存在一个非常靠近肾上腺静脉的肿瘤，导致无法正确保留残余肾上腺体积（n = 4），以及1例与肾上腺实质等荧光的肿瘤。
ICG荧光引导有助于术中选择患者以成功保留皮质。
