A Novel Use of Near-Infrared Fluorescence Imaging During Robotic Surgery Without Contrast Agents

We describe a novel use of near-infrared fluorescence (NIRF) imaging without contrast agents, like indocyanine green, to identify otherwise obscured intraluminal areas of interest during robot-assisted laparoscopic (RAL) surgery marked by the white light (WL) of endoscopic instruments. By filtering light wavelengths below near-infrared, NIRF imaging causes the WL of the endoscopes to illuminate green while allowing simultaneous vision of the surrounding tissues. With this visualization, intraoperative ureteroscopy was used to identify the extent of a ureteral stricture in a patient undergoing RAL partial ureterectomy. Cystoscopy was used to identify bladder diverticula and tumor locations in three patients undergoing RAL partial cystectomy with or without diverticulectomy and the ureteral orifice in another patient undergoing RAL nephroureterectomy. This technique enabled more precise identification of important areas and successful completion of RAL surgery in these five patients, which serves as proof of concept for broader applications in RAL surgery.