Using Indocyanine Green and Near-Infrared Fluorescence Technology to Identify the “Landmark Artery” During Robot-Assisted Radical Prostatectomy

Abstract

Introduction and Objectives:

The “Landmark Artery” has been shown to be a valuable landmark during nerve-sparing (NS) robot assisted radical prostatectomy (RARP) in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes, this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. We performed the first ever study to evaluate the role of an innovative intraoperative tool, near-infrared fluorescence (NIRF) technology in conjunction with intravenous indocyanine green (ICG) in identification of this “Landmark Artery” during NS RARP. We demonstrate our technique in this video.

Methods:

Ten patients underwent NS RARP. Before clamping the pedicle or dissection of the NVB, 0.75 ml of ICG was given. The NIRF technology was engaged on the robotic console and a period of 20–40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period, we switched back to the non-NIRF mode and proceeded without the normal NS operation. Data were collected regarding the % chance of being able to visualize this landmark in 10 patients.

Results:

In 10 patients, 20 NVBs were examined with the ICG and NIRF technology. The landmark prostatic artery and its pathway could be identified in 17/20 NVBs (85%). In the other three patients, we were unable to visualize the artery as it was beneath some large veins. The artery was seen visually in these patients during the normal NS surgery. The use of ICG did not significantly increase the operative time or result in any immediate or long-term complications.

Conclusions:

The use of ICG and NIRF technology during NS radical prostatectomy has the potential to more accurately and more frequently identify the landmark prostatic artery that runs along the medial aspect of NVBs. For experienced and novice surgeons, the pathway of this artery is valuable for NS and can help to improve quality of the NVB preservation.

No competing financial interests exist.

Runtime of video: 7 mins 33 secs