Purpose: With the availability of near-infrared fluorescence (NIRF) imaging using indocyanine green dye (ICG) to the robotic platform, utility of this imaging technology has evolved significantly across the board for ablative and reconstructive procedures. Herein, we describe the potential indications of indocyanine green for both oncologic and non-oncologic applications in robot-assisted laparoscopic urologic surgery.
Methods: A narrative mini-review was performed in November 2018 using PubMed, Scopus, EMBASE, and Web of Science databases utilizing the following search phrase: "indocyanine green fluorescence robotic surgery" resulting in 104 articles of which 30 articles had urologic-pertinent applications. All 30 articles, and the references within, were reviewed and judged for scientific integrity and merit. Articles with non-novel findings or similar conclusions to original papers were omitted.
Results: ICG does not have a urologic FDA indication, though it has been used off-label for urologic surgery since 2006. Fluorescence-augmented surgery with ICG can facilitate oncologic surgery in the adrenal gland, kidney, bladder, prostate, and retroperitoneum, in addition to lymph node dissection for various malignant pathologies. ICG-NIRF can enhance non-oncologic surgery including ureterolysis, ureteroureterostomy, ureteral re-implantation, pyeloplasty, and urinary diversion in both the adult and pediatric populations.
Conclusions: Although it is not necessary to utilize fluorescence-enhanced surgery in all cases, the authors find the utilization of ICG-NIRF in complex and highly technical surgeries useful.
Keywords: Adrenalectomy; Cystectomy; ICG; Kidney; Laparoscopy; Molecular guided; Nephroureterectomy; Partial nephrectomy; Prostatectomy; Pyeloplasty; Reconstruction; Robot; Robotic; Ureter; Urinary diversion.