Does ICG use during R-VEIL provide relevant clinical advantages? Technical aspects and preliminary results

Introduction Robotic video endoscopic inguinal lymphadenectomy (R-VEIL) is a minimally invasive alternative to open inguinal lymphadenectomy. The procedure reduce morbidity and maintains oncological efficacy. The integration of indocyanine green (ICG) fluorescence imaging may enhance the accuracy of lymphatic mapping and the identification of lymph nodes. Objective To evaluate the impact of ICG fluorescence guidance on lymph node retrieval and postoperative outcomes in R-VEIL for penile cancer. Methods Seven patients with clinical stage T1b-T3N0–1 squamous cell carcinoma of the penis underwent bilateral R-VEIL. ICG was injected subcutaneously at the penile shaft before the procedure beginning, and fluorescence imaging was used to visualize lymphatic drainage and to improve nodal identification. The number of lymph nodes retrieved and postoperative lymphatic complications were compared between ICG-guided and non-ICG procedures. Results The mean number of lymph nodes removed was higher in the ICG group (10 vs. 8). The mean drainage removal time was shorter in the ICG group (5 vs. 8 days), suggesting a reduction in lymphatic leakage. Only one patient in the ICG group (14.3%) required puncture for symptomatic lymphocele, compared to two patients (28.6%) in the non-ICG group. Conclusion ICG fluorescence guidance in R-VEIL enhances lymph node detection and may contribute to improved postoperative outcomes. Further studies with larger cohorts are needed to confirm these findings.