V907: A Novel use of ICG-NIRF during robotic assisted partial adrenalectomy

Video

Introduction and Objectives
Indocyanine green (ICG) has been previously described in the urologic literature using an intravenous technique during robotic partial nephrectomy. During parital nephrectomy, the dye is administered allowing visualization of the vascular anatomy of the renal hilum, as well as allowing visualization of the tumor margins due to differential fluorescence of the mass relative to the normal parenchyma. We hypothesized that the same rational could be applied to the management of adrenal lesions. We describe our technique of intravascular injection of ICG in a patient with an adrenal pheochromocytoma to help delineate adrenal vascular anatomy and further visualize the tumor-normal adrenal margin.

Methods
We utilize intravascular injection of 2ml of ICG dye with a concentration of 2.5mg/ml to help us assess the the visualization of the adrenal tumor and its differential fluorescence to assist us in performing partial adrenalectomy.

Results
Administration of the dye allowed successful distinction of the adrenal tumor from surrounding structures. The tumor was hypo fluorescent relative to the liver and normal adrenal gland. This allowed us to successfully perform partial adrenalectomy with negative tumor margins.

Conclusions
In conclusion, we demonstrate our technique of robotic assisted adrenalectomy with utilization of intravascualar indocyanine green for identification of tumor margins to aid in excision of difficult masses.

Funding: None