Abstract
ABSTRACTThe intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe.
Highlights
Intraoperative identification of certain anatomical structures may be challenging
Near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms and become commercially available since 2011
The technique consists of bolus injection of the drug in peripheral veins, regional vessels, or submucosal or subserosal.(6) The safe dose recommended for a standard diagnostic procedure is 0.1 to 0.5mg/kg, which is stimulated with infrared laser light responding with a highly intense fluorescent signal that is captured by special cameras in combination or not with visible spectrum images.(7)
Summary
Intraoperative identification of certain anatomical structures may be challenging. Small parts, such as lymph nodes, relevant in an oncologic operation, or structures visually occult to the eye may be left behind due to its intraparenchymal situation or low contrast with surrounding environment that may be damaged or require a great deal of dissection to be located.(1) The development of minimally invasive surgery brought countless advantages over conventional surgery. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados.
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