Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green

TL;DR

This study shows that using indocyanine green with near-infrared imaging helps surgeons better identify and remove abdominal paragangliomas during minimally invasive surgery.

Contribution

The study demonstrates the feasibility of using ICG-fluorescence for real-time intraoperative guidance in resecting abdominal paragangliomas.

Findings

NIR fluorescence identified all four paraganglioma lesions, outperforming white-light visualization.

Homogeneous fluorescence signals appeared 30–60 seconds after ICG administration and lasted up to 30 minutes.

The method proved valuable for lesion detection and resection in challenging anatomical cases.

Abstract

This retrospective study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas. They can be challenging to detect during minimally invasive surgery, due to their anatomical location, varying size and similar appearance in regard to their surrounding tissue. Patients with suspected abdominal paragangliomas planned for a minimally-invasive resection were included. As part of standard of care they received single intravenous dose of 5 mg ICG after abdominal exploration. NIR fluorescence imaging of the anatomical region of the suspected lesion was performed immediately following intravenous administration, to assess fluorescence signals, intraoperative identification, and histopathological correlation. Out of five resected suspicious lesions, four were imaged with NIR fluorescence, pathology confirming four as paragangliomas, the latter turned out to be an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30–60 s post-ICG administration, which lasted up to 30 min. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.

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