Jesse Gutnick, MD, Eren Berber, MD. Cleveland Clinic
1. Objective of the technology
Adrenal surgery is facilitated by intraoperative mapping technology to differentiate adrenal tissue from the retroperitonium. Traditionally, this has been accomplished with ultrasonography. However, ultrasound requires interpretation and mental integration with the video image to create mental visualization of the anatomy. Indocyanine green (ICG) fluorescence imaging allows for real-time anatomic differentiation during adrenal surgery.
2. Description of the technology
ICG was FDA approved in 1959. It is currently clinically used for florescence angiography. Endocrine tissue preferentially takes up ICG due to high vascularity. Modern laparoscopy allows for integration of ICG florescence imaging and video laparoscopy. This video-florescence integration facilitates frequent anatomic feed-back to the surgeon.
3. Preliminary results
ICG florescence imaging is being studied under an IRB approved study at our institution. This video demonstrates its utility in adrenal surgery. The adrenal tissue is well differentiated from the retroperitonal adipose tissue. The liver and pancreas also take up ICG well, but the retroperitonal tissue planes that separate these organs are well demonstrated. Frequent anatomic feedback differentiates adrenal tissue from the surrounding retroperitonium.
4. Future Directions
Our group is formally analyzing the utility of ICG florescence imaging in comparison to traditional video and ultrasound techniques in laparoscopic surgery.