Preliminary clinical experiences of fluorescence imaging in Robot-assisted radical prostatectomy

doi:10.3877/cma.j.issn.1674-3253.2020.06.004

Abstract

Abstract:

Objective

To explore the clinical utilization value of fluorescent lymphnodes detection with Indocyanine Green (ICG) in robotic prostatectomy and pelvic lymphnode dissection.

Methods

In this study, from Jan. 2018 to Dec. 2018, 60 prostate cancer patients, 30 in fluorescence guided surgery group and 30 in control group, who underwent robotic prostatectomy in the First Hospital of Shanxi Medical University. And their clinical data were retrospectively analyzed. Among 30 patients with fluorescence guided surgery, the average age was (62±8) years, BMI was (22.8±1.4) kg/m², PSA level was (81.2±1.2) ng/dl, prostatic volume was(57.5±1.4) ml and 14(46.73%) patients with Gleason score ≤7. In the control group, the average age was (61±7) years, BMI was (22.7±1.3) kg/m², PSA level was (82.4±1.2) ng/dl, prostatic volume was (56.9±1.3) ml and 11(43.30%) patients with Gleason score ≤7. All parameters were comparable between the two groups. Patients in study group, before the prostatectomy, received endorectal ultrasound guided transperineal prostatic injection of ICG (5 mg). Firefly endoscopy were utilized during the fluorescent lymph nodes resection. Resected lymph tissue was marked, counted and sent to pathology. Intraoperative and postoperative data was collected, no significant differences were found in incidence of advert events and biochemical reccurence.

Results

Among patients received endorectal ultrasound guided transperineal prostate ICG injection, one case had leakage. In all 30 patients, it was able to identify fluorescent prostatic capsule which were well distincted from adjacent structures. Fluorescence lymph node (FLN) packets were observed in all 30 patients and fluorescence guided resected tissue was pathologically confirmed lymph tissue. There were total 970 lymph nodes resected in both groups, 526(17.5/person) in study groups, which was significantly more than the control group 444(14.8/person). Total fluorescence rate in study group was 89.6%. Postoperative complications and incidence of reccurence was comparable.

Conclusion

Transperineal injection ICG induced fluorescence guided robotic assisted prostatectomy was proved stable and reliable in this study which could be used as guidance of surgical resection strategy.

Key words: Indocyanine green, Prostate cancer, Fluorescence imaging, Robot, Lymph node resection

Bo Wu, Caoyang Hu, Pengliang Shen, Nan Yin, Tao Bai, Yuan Shao, Dongwen Wang. Preliminary clinical experiences of fluorescence imaging in Robot-assisted radical prostatectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(06): 414-419.

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Figures/Tables 4

References 15

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组别	例数	年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	前列腺体积[ml，(±s)]	术前PSA[ng/dl，(±s)]	Gleason评分≤7[例，(%)]	Gleason评分>7[例，(%)]	手术时间[min，(±s)]	出血量[ml，(±s)]
研究组	30	62±8	22.8±1.4	57.5±1.4	81.2±1.2	14(46.7)	16(53.3)	155±7	93±4
对照组	30	61±7	22.7±1.3	56.9±1.3	82.4±1.2	13(43.3)	17(56.7)	156±7	94±4
统计值		t=0.542	t=0.154	t=1.631	t=0.304	χ²=0.067		t=0.491	t=0.439
P值		0.590	0.878	0.108	0.762	0.795		0.625	0.662

组别	例数	年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	前列腺体积[ml，(±s)]	术前PSA[ng/dl，(±s)]	Gleason评分≤7[例，(%)]	Gleason评分>7[例，(%)]	手术时间[min，(±s)]	出血量[ml，(±s)]
研究组	30	62±8	22.8±1.4	57.5±1.4	81.2±1.2	14(46.7)	16(53.3)	155±7	93±4
对照组	30	61±7	22.7±1.3	56.9±1.3	82.4±1.2	13(43.3)	17(56.7)	156±7	94±4
统计值		t=0.542	t=0.154	t=1.631	t=0.304	χ²=0.067		t=0.491	t=0.439
P值		0.590	0.878	0.108	0.762	0.795		0.625	0.662

组别	例数	肿瘤分期		淋巴结		术后尿漏		淋巴漏		切缘阳性		尿失禁
组别	例数	局限性(<pT2)	进展性(≥pT3)	普通	癌性	是	否	是	否	是	否	是	否
对照组	30	21(70.0)	9(30.0)	429(99.1)	15(0.9)	1(3.3)	29(96.7)	5(16.7)	25(83.3)	4(13.3)	26(86.7)	1(3.3)	29(96.7)
研究组	30	23(76.7)	7(23.3)	498(98.7)	28(1.3)	1(3.3)	29(96.7)	2(6.7)	28(93.3)	0(0)00	30(100)	1(3.3)	29(96.7)
χ²值		0.085		1.715		0		0.647		2.410		0
P值		0.770		0.190		1		0.421		0.121		1

组别	例数	肿瘤分期		淋巴结		术后尿漏		淋巴漏		切缘阳性		尿失禁
组别	例数	局限性(<pT2)	进展性(≥pT3)	普通	癌性	是	否	是	否	是	否	是	否
对照组	30	21(70.0)	9(30.0)	429(99.1)	15(0.9)	1(3.3)	29(96.7)	5(16.7)	25(83.3)	4(13.3)	26(86.7)	1(3.3)	29(96.7)
研究组	30	23(76.7)	7(23.3)	498(98.7)	28(1.3)	1(3.3)	29(96.7)	2(6.7)	28(93.3)	0(0)00	30(100)	1(3.3)	29(96.7)
χ²值		0.085		1.715		0		0.647		2.410		0
P值		0.770		0.190		1		0.421		0.121		1

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