Using Indocyanine Green and Near-Infrared Fluorescence Technology to Identify the “Landmark Artery” During Robot-Assisted Radical Prostatectomy

Abstract

Abstract Introduction and Objectives: The “Landmark Artery” has been shown to be a valuable landmark during nerve-sparing (NS) robot assisted radical prostatectomy (RARP) in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes, this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. We performed the first ever study to evaluate the role of an innovative intraoperative tool, near-infrared fluorescence (NIRF) technology in conjunction with intravenous indocyanine green (ICG) in identification of this “Landmark Artery” during NS RARP. We demonstrate our technique in this video. Methods: Ten patients underwent NS RARP. Before clamping the pedicle or dissection of the NVB, 0.75 ml of ICG was given. The NIRF technology was engaged on the robotic console and a period of 20–40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period, we switched back to the non-NI...