Pd22-11 Intraoperative Angiography of the Neurovascular Bundle Using Indocyanine Green and Near-Infrared Fluorescence Improves Anatomical Dissection During Robot-Assisted Radical Prostatectomy: Initial Clinical Experience

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-11 INTRAOPERATIVE ANGIOGRAPHY OF THE NEUROVASCULAR BUNDLE USING INDOCYANINE GREEN AND NEAR-INFRARED FLUORESCENCE IMPROVES ANATOMICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: INITIAL CLINICAL EXPERIENCE Nordine Amara, Tarek Al Youssef, Jordan Massa, Adel Ait Kaki, Patricia Gutierrez, Belur Patel, and Elias Elkhouri Nordine AmaraNordine Amara , Tarek Al YoussefTarek Al Youssef , Jordan MassaJordan Massa , Adel Ait KakiAdel Ait Kaki , Patricia GutierrezPatricia Gutierrez , Belur PatelBelur Patel , and Elias ElkhouriElias Elkhouri View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In light of contemporary insights into prostate surgical anatomy, this study explores the utility of intraoperative angiography employing indocyanine green (ICG) and near-infrared fluorescence during robot-assisted radical prostatectomy (RARP) for enhanced dissection and preservation of the neurovascular bundle (NVB). METHODS: Between June 2016 and February 2023, 387 patients afflicted with localized prostate cancer underwent RARP employing the Da Vinci® Xi system (Intuitive Surgical). Notably, 91 of these cases involved RARP combined with intraoperative angiography utilizing the Firefly® fluorescence imaging system. Our analysis focused on the percentage of bilateral NVB identification, facilitating dissection optimization and examining any complications related to ICG. Subsequently, postoperative patient follow-ups occurred at intervals of 3, 6, 9, and 12 months, assessing erectile function via the Sexual Health Inventory for Men (SHIM) scores. RESULTS: In all instances, bilateral NVBs were successfully identified without impediment, and no ICG-related complications or allergic reactions were observed. The real-time angiography during surgery allowed for precise visualization and microdissection of the NVB, employing fluorescence in conjunction with standard lighting. Importantly, patients who underwent this nerve-sparing RARP with fluorescence imaging assistance demonstrated a notable enhancement in postoperative erectile function. CONCLUSIONS: Fluorescence-guided surgery presents a straightforward and promising non-invasive methodology for the revelation and identification of critical anatomical landmarks, with the aim of optimizing micro-preservation of the NVB and, consequently, preserving erectile function. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e465 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nordine Amara More articles by this author Tarek Al Youssef More articles by this author Jordan Massa More articles by this author Adel Ait Kaki More articles by this author Patricia Gutierrez More articles by this author Belur Patel More articles by this author Elias Elkhouri More articles by this author Expand All Advertisement PDF downloadLoading ...