Robot‐Assisted Laparoscopic Partial Adrenalectomy Utilizing Intraoperative Indocyanine Green Near‐Infrared Fluorescence Imaging for Pheochromocytoma: A Case Report
Nae Takizawa, Haruyuki Ohsugi, Monta Inoue, Jun Matsushita, Hisanori Taniguchi, Hidefumi KinoshitaABSTRACT
Introduction
Indocyanine green (ICG) near‐infrared fluorescence (NIRF) imaging facilitates pheochromocytoma identification during adrenal surgery.
Case Presentation
We report a 21‐year‐old woman with multiple endocrine neoplasia type 2A and bilateral adrenal tumors who underwent ICG‐NIRF–guided, robot‐assisted partial adrenalectomy for pheochromocytomas. Following left adrenalectomy, partial right adrenalectomy was performed using intraoperative ICG‐NIRF imaging. After intravenous administration of 2.5 mg ICG, the normal adrenal cortex exhibited strong fluorescence, whereas the pheochromocytoma showed no fluorescence. However, fluorescence from the overlying normal adrenal cortex partially obscured the tumor, which was identified by intraoperative ultrasonography. Combined ICG‐NIRF imaging and ultrasonography enabled maximal preservation of functional adrenal cortex. Postoperatively, metanephrine and normetanephrine levels normalized, and hydrocortisone was tapered and discontinued.
Conclusion
ICG‐NIRF is a useful adjunct for cortical visualization; however, multimodal guidance is essential for precise tumor delineation during cortical‐sparing adrenalectomy.