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. 2024 Dec;76(8):2851-2862.
doi: 10.1007/s13304-024-01966-5. Epub 2024 Aug 27.

Impact of indocyanine green on decision making for performing laparoscopic cortical sparing adrenalectomy

Martos Martínez Juan Manuel  1 , Rubio-Manzanares Dorado Mercedes  2 , Pino Díaz Verónica  1 , Padillo Ruíz Javier  1
Affiliations

Impact of indocyanine green on decision making for performing laparoscopic cortical sparing adrenalectomy

Martos Martínez Juan Manuel et al. Updates Surg. 2024 Dec.

Abstract

Background: Indocyanine green imaging (ICG) is an expansion technology that can contribute to the development of demanding techniques such as cortical-sparing adrenalectomy (CSA). The aim of this study was to determine in which cases CSA should be performed and when total adrenalectomy should be performed instead based on ICG fluorescence. Here, we present our experience through a series of cases and videos.

Methods: Prospective and descriptive study on patients with surgical adrenal lesions who were proposed for CSA using ICG with near-infrared fluorescence imaging in our center. A first bolus of 6,25 mg ICG was administered intravenously upon exposure of the retroperitoneal plane. Fluorescence was visualized using a Storz® NIR/ICG endoscopic system.

Results: Seven patients were proposed for CSA. After the application of ICG, a change in attitude was carried out in 71.4% of the cases (five of seven). In the two patients in whom CSA could be performed, the adrenal remnants were functional, and the resection margins of the surgical specimens were free of disease. The reasons why partial adrenalectomy could not be completed, and a total adrenalectomy was decided instead were the presence of a tumor located very close to the adrenal vein that prevented a correct remnant volume (n = 4) and one case of isofluorescent tumor with the adrenal parenchyma.

Conclusion: ICG fluorescence guidance could help in the decision making to select patients intraoperatively for successful cortical preservation.

Keywords: Cortical sparing adrenalectomy; ICG; Indocyanine green fluorescence; Partial adrenalectomy.

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Conflict of interest statement

Declarations. Conflict of interest: All authors meet the criteria for authorship in the Consensus Statement on Journal Authorship. There are not conflicts of interest. Ethical approval and research involving human participants and/or animals: All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee for clinical research at the Virgen del Rocio University Hospital (Seville, Spain). (No. e75cfdea9355c3b559aa3a8b4a44ecc7f2281467). Informed consent: Informed consent was obtained for surgical procedure prior to their participation.

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