A Novel Use of Near-Infrared Fluorescence Imaging During Robotic Surgery Without Indocyanine Green

Abstract

Abstract Introduction: In addition to enhanced magnification, the da Vinci® Surgical System offers the ability to display near-infrared fluorescence (NIRF) imaging. NIRF imaging has previously been described in conjunction with the administration of the fluorophore indocyanine green (ICG). The principle urologic application of NIRF imaging has been to distinguish normal parenchyma from tumor during partial nephrectomy with intravenous ICG. We describe a novel use of NIRF imaging without ICG to identify intraluminal areas of interest during robotic-assisted laparoscopic (RAL) surgery marked by the white light (WL) of endoscopes. Materials and Methods: A single surgeon performed RAL surgery on six patients aided by NIRF imaging to visualize the areas of interest marked by the WL of endoscopic instruments. Patient 1 underwent RAL partial ureterectomy with a psoas hitch and Boari flap with left ureteroscopy for ureteral stricture. Patients 2 and 3 underwent RAL diverticulectomies with cystoscopy for urothelia...