1. Near Infrared Fluorescence Imaging After Intravenous Indocyanine Green: Initial Clinical Experience With Open Partial Nephrectomy for Renal Cortical Tumors
- Author
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Jorge L. Yao, Hani Rashid, Eric A. Singer, Jonah Marshall, Scott Tobis, Joy Knopf, Ralph Madeb, Guan Wu, Allison Cardin, Christopher Silvers, Dragan Golijanin, Edward M. Messing, Jay E. Reeder, Ronald W. Wood, and Erdal Erturk
- Subjects
Indocyanine Green ,medicine.medical_specialty ,Near-Infrared Fluorescence Imaging ,Kidney Cortex ,Urology ,Nephrectomy ,Cold Ischemia Time ,Fluorescence ,Adipose capsule of kidney ,Intraoperative Period ,chemistry.chemical_compound ,Parenchyma ,medicine ,Carcinoma ,Humans ,Open partial nephrectomy ,Coloring Agents ,Carcinoma, Renal Cell ,business.industry ,medicine.disease ,Kidney Neoplasms ,chemistry ,Injections, Intravenous ,Radiology ,business ,Indocyanine green - Abstract
Objective To evaluate the safety of near infrared fluorescence (NIRF) of intravenously injected indocyanine green (ICG) during open partial nephrectomy, and to demonstrate the feasibility of this technology to identify the renal vasculature and distinguish renal cortical tumors from normal parenchyma. Methods Patients undergoing open partial nephrectomy provided written informed consent for inclusion in this institutional review board-approved study. Perirenal fat was removed to allow visualization of the renal parenchyma and lesions to be excised. The patients received intravenous injections of ICG, and NIRF imaging was performed using the SPY system. Intraoperative NIRF video images were evaluated for differentiation of tumor from normal parenchyma and for renal vasculature identification. Results A total of 15 patients underwent 16 open partial nephrectomies. The mean cold ischemia time was 26.6 minutes (range 20-33). All 14 malignant lesions were afluorescent or hypofluorescent compared with the surrounding normal renal parenchyma. NIRF imaging of intravenously injected ICG clearly identified the renal hilar vessels and guided selective arterial clamping in 3 patients. No adverse reactions to ICG were noted, and all surgical margins were negative on final pathologic examination. Conclusion The intravenous use of ICG combined with NIRF is safe during open renal surgery. This technology allows the surgeon to distinguish renal cortical tumors from normal tissue and highlights the renal vasculature, with the potential to maximize oncologic control and nephron sparing during open partial nephrectomy. Additional study is needed to determine whether this imaging technique will help improve the outcomes during open partial nephrectomy.
- Published
- 2012