title: Near infrared fluorescence imaging after intravenous indocyanine green: initial clinical experience with open partial nephrectomy for renal cortical tumors.
abstract: OBJECTIVE
  To evaluate the safety of near infrared fluorescence (NIRF) of intravenously injected indocyanine green (ICG) during open partial nephrectomy, and to demonstrate the feasibility of this technology to identify the renal vasculature and distinguish renal cortical tumors from normal parenchyma.
  
  
  METHODS
  Patients undergoing open partial nephrectomy provided written informed consent for inclusion in this institutional review board-approved study. Perirenal fat was removed to allow visualization of the renal parenchyma and lesions to be excised. The patients received intravenous injections of ICG, and NIRF imaging was performed using the SPY system. Intraoperative NIRF video images were evaluated for differentiation of tumor from normal parenchyma and for renal vasculature identification.
  
  
  RESULTS
  A total of 15 patients underwent 16 open partial nephrectomies. The mean cold ischemia time was 26.6 minutes (range 20-33). All 14 malignant lesions were afluorescent or hypofluorescent compared with the surrounding normal renal parenchyma. NIRF imaging of intravenously injected ICG clearly identified the renal hilar vessels and guided selective arterial clamping in 3 patients. No adverse reactions to ICG were noted, and all surgical margins were negative on final pathologic examination.
  
  
  CONCLUSIONS
  The intravenous use of ICG combined with NIRF is safe during open renal surgery. This technology allows the surgeon to distinguish renal cortical tumors from normal tissue and highlights the renal vasculature, with the potential to maximize oncologic control and nephron sparing during open partial nephrectomy. Additional study is needed to determine whether this imaging technique will help improve the outcomes during open partial nephrectomy.
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Tobis
authors.forename: Joy K
authors.initials: JK
authors.lastname: Knopf
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Silvers
authors.forename: Jonah
authors.initials: J
authors.lastname: Marshall
authors.forename: Allison
authors.initials: A
authors.lastname: Cardin
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Wood
authors.forename: Jay E
authors.initials: JE
authors.lastname: Reeder
authors.forename: Erdal
authors.initials: E
authors.lastname: Erturk
authors.forename: Ralph
authors.initials: R
authors.lastname: Madeb
authors.forename: Jorge
authors.initials: J
authors.lastname: Yao
authors.forename: Eric A
authors.initials: EA
authors.lastname: Singer
authors.forename: Hani
authors.initials: H
authors.lastname: Rashid
authors.forename: Guan
authors.initials: G
authors.lastname: Wu
authors.forename: Edward
authors.initials: E
authors.lastname: Messing
authors.forename: Dragan
authors.initials: D
authors.lastname: Golijanin
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D004396:Coloring Agents; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D007275:Injections, Intravenous; D007432:Intraoperative Period; D007672:Kidney Cortex; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green