title: Near-infrared fluorescence imaging can help identify the contralateral phrenic nerve during robotic thymectomy.
abstract: OBJECTIVE
  Unilateral robotic thymectomy is gaining popularity. Identifying the contralateral phrenic nerve is a key limitation to achieving maximal thymic tissue resection. We evaluated the feasibility and technique of fluorescence imaging on the daVinci-Si robot (Intuitive Surgical Inc, Sunnyvale, CA) to identify the contralateral periocardiophrenic neurovascular bundle (PNB).
  
  
  METHODS
  A unilateral right robotic thymectomy was performed in 10 patients. The thymus and its poles were mobilized. Indocyanine green was injected and fluoresced to identify the left PNB in four different viewing angles to assess the view that consistently positively identified the PNB.
  
  
  RESULTS
  No complications from indocyanine green or injuries to the phrenic nerve occurred. The contralateral PNB was visualized in 80% of patients from a left pleural view, infrequently from a mediastinal view, and never distal to the aortopulmonary window.
  
  
  CONCLUSIONS
  During right robotic thymectomy, fluorescence imaging facilitates identification of the contralateral phrenic nerve by fluorescing the pericardiophrenic vessels. It is best visualized from a left pleural view. This technology has the potential to maximize thymic tissue resection with a unilateral approach while reducing operative time and nerve injury.
authors: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington 98104, USA.
authors: Oliver J
authors: OJ
authors: Wagner
authors: Brian E
authors: BE
authors: Louie
authors: Eric
authors: E
authors: Vallières
authors: Ralph W
authors: RW
authors: Aye
authors: Alexander S
authors: AS
authors: Farivar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000033:anatomy & histology*; D012371:Robotics; D013934:Thymectomy / Q000379:methods*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green