[Injection of indocyanine green by vasopuncture in fluorescence laparoscopic radical prostatectomy].

Abstract

Objective: To investigate the clinical application value of injection of indocyanine green (ICG) via vasopuncture in fluorescence laparoscopic radical prostatectomy (FLRP).

Methods: We retrospectively analyzed the clinical data on 50 cases of PCa treated by injection of ICG via vasopuncture in FLRP. The patients were aged (70.60 ± 5.67) years old, with an average PSA value of (18.42 ± 2.69) μg/L. During the operation, we injected ICG at 0.5 ml by vasopuncture through the vas deferens at each side of the scrotum, observed the visualized images of the vas deferens and seminal vesicles using normal high-definition, black-and-white fluorescence, green fluorescence, and color fluorescence respectively, and then isolated the adherent seminal vesicles under the laparoscope.

Results: A total of 93 injections of ICG were completed, 86 bilaterally, 4 on the right and 3 on the left. The vas deferens and seminal vesicles were visualized in 41 cases (60 sides, 64.52%), 19 bilaterally, 7 on the right and 15 on the left. Spillage of the fluorescent agent occurred in 9 cases during the incision of the bladder neck and adhesion of the seminal vesicles was found intraoperatively in 10 cases, in which the seminal vesicles were all quickly located by fluorescence visualization. No rectal injury occurred during the surgery. Mild scrotal subcutaneous bruises were observed in 2 cases, with a postoperative pathological Gleason's score of 7.44 ± 0.88.

Conclusion: Injection of ICG by vasopuncture is minimally invasive and safe. ICG-mediated near-infrared imaging and real-time fluorescence imaging of the vas deferens and seminal vesicles can achieve precise positioning and removal of the seminal vesicles and prostate gland without causing rectal injury.