V10-01 ICG-GUIDED ROBOTIC-ASSISTED PARTIAL ADRENALECTOMY

Abstract

You have accessJournal of UrologyAdrenal Surgery & Kidney Cancer II (Advanced Kidney Cancer & Vascular Reconstruction) (V10)1 Apr 2020V10-01 ICG-GUIDED ROBOTIC-ASSISTED PARTIAL ADRENALECTOMY Mariaconsiglia Ferriero*, Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Bove, Aldo Brassetti, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Mariaconsiglia Ferriero*Mariaconsiglia Ferriero* More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo BoveAlfredo Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000935.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Near Infrared Fluorescence Imaging (NIFI) with Indocyanine Green (ICG) applied to robotic platforms can facilitate surgery in many urologic settings. Concerning adrenal surgery, ICG was of greater benefit in cortical lesions, as these tumors tended to be hyperfluorescent compared to surrounding retroperitoneal tissues. The video shows a case of ICG-guided robotic partial adrenalectomy (RPA). METHODS: We present a case of a 54-year old female patient with a 1 cm left adrenal aldosterone-secreting lesion. Patient was symptomatic and required hypotensive treatment. Serum aldosteron levels were increased. Patient was placed in extended flank position and side docking. A transperitoneal five-port access was performed using a 30° scope. Once the adrenal gland was identified, under NIFI, the adrenal nodule appeared hyperintense compared to the adrenal parenchyma. The lesion was progressively mobilized following the pseudocapsule plane. A blunt and sharp dissection using monopolar scissors was employed to maximize adrenal parenchyma preservation. Blood pressure was carefully monitored intraoperatively to ensure hemodynamic stability during the procedure. The dissection was carried out without any isolation of adrenal vessels, in order to avoid accident or injury to adrenal vessels. The remnant adrenal margins were approximated with a sliding-clip running suture (3/0 Monocryl). RESULTS: Operative time was 60 minutes. Blood loss was 180 ml. Post-operative course was uneventful. Blood Pressure was normalized without the need of medications. Patient was discharged on second post-operative day. Pathologic examination showed an adenoma of adrenal cortex. At three-month follow up, no antihypertensive medications were needed. Aldosteron levels returned to normal values. A Complete Clinical Success according to PASO classification was obtained. CONCLUSIONS: ICG-guided RPA is a safe and feasible procedure, providing excellent functional outcomes. The real time feed-back of ICG technology is best suited for small lesions to improve visualization of resection margins and to minimize unintended resection of healthy parenchyma. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e931-e931 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mariaconsiglia Ferriero* More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Bove More articles by this author Aldo Brassetti More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...