Robotic Partial Adrenalectomy Using Indocyanine Green Dye With Near-infrared Imaging: The Initial Clinical Experience

Abstract

To present the initial clinical experience with robot-assisted partial adrenalectomy using indocyanine green dye with near-infrared fluorescence (ICG-NIRF) imaging. Three consecutive patients with solitary adrenal masses with worrisome features were referred for treatment. The preoperative workup included dedicated axial imaging and adrenal function studies. All patients underwent purely robotic partial adrenalectomy with ICG-NIRF guidance. Relevant steps of the technique included a transperitoneal approach, gross identification of the adrenal gland, administration of 5mg intravenous ICG, and finally, mass resection guided by ICG-NIRF and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. Robotic partial adrenalectomy was successfully performed with negative margins in all patients. All masses were hypofluorescent relative to normal adrenal tissue with ICG-NIRF and included a pheochromocytoma, lipoadenoma, and follicular lymphoid hyperplasia. Robotic partial adrenalectomy with intraoperative ICG-NIRF is safe and feasible. The addition of ICG-NIRF may help mass identification, excision, and promote the use adrenal-sparing surgery.