title: The utility of indocyanine green fluorescence imaging during robotic adrenalectomy.
abstract: OBJECTIVE
  Indocyanine green (ICG) has been used for medical imaging since 1950s, but has more recently become available for use in minimally invasive surgery owing to improvements in technology. This study investigates the use of ICG florescence to guide an accurate dissection by delineating the borders of adrenal tumors during robotic adrenalectomy (RA).
  
  
  METHODS
  This prospective study compared conventional robotic view with ICG fluorescence imaging in 40 consecutive patients undergoing RA. Independent, non-blinded observers assessed how accurately ICG fluorescence delineated the borders of adrenal tumors compared to conventional robotic view.
  
  
  RESULTS
  A total of 40 patients underwent 43 adrenalectomies. ICG imaging was superior, equivalent, or inferior to conventional robotic view in 46.5% (n = 20), 25.6% (n = 11), and 27.9% (n = 12) of the procedures. On univariate analysis, the only parameter that predicted the superiority of ICG imaging over conventional robotic view was the tumor type, with adrenocortical tumors being delineated more accurately on ICG imaging compared to conventional robotic view.
  
  
  CONCLUSIONS
  This study demonstrates the utility of ICG to guide the dissection and removal of adrenal tumors during RA. A simple reproducible method is reported, with a detailed description of the utility based on tumor type, approach and side. J. Surg. Oncol. 2016;114:153-156. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Colvin
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nisar
authors.initials: N
authors.lastname: Zaidi
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.|Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*
chemical_list: D007208:Indocyanine Green
keywords: endocrine surgery; fluorescence-guided; indocyanine green; minimally invasive; near-infrared imaging; robotic adrenalectomy