Robot assisted nerve sparing radical prostatectomy using near infrared fluorescence technology and Indocyanine Green: initial experience

Mario Salvatore Mangano1, Francesco Beniamin1, Alberto De Gobbi1, Claudio Lamon1, Matteo Ciaccia1, Luigino Maccatrozzo1
  • 1 Azienda U.L.S.S. n 2 Marca Trevigiana, Ospedale di Treviso, U.O. Urologia (Treviso)


The use of Indocyanine green (ICG) with near infrared (IR) fluorescence is a consolidated technology to visualize edge lesions in laparoscopic robot-assisted nephron sparing surgery and is actually used in robotic assisted partial nephrectomy. Instead, we propose the use of the ICG with near IR fluorescence during laparoscopic robot assisted radical prostatectomy (RARP), to identify and improve the preservation of neurovascular bundle and the hemostasis.

Materials and Methods

From April, 2015 to February, 2016, 62 patients underwent to RARP in our Urology Unit. In 26 of these, in the attempt to have a better visualization of neurovascular bundles, we used to inject ICG during the procedure, as described below. After the bladder neck incision and seminal vescicles dissection, we injected 1,25ml of ICG. Then we proceeded to bilateral pedicles resection only after the visualization of arterious vessels location, through IR technology. Just after the visualization with IR technology, the dissection was performed by non electrified scissors and Hem-o-lok Ligation System, with non IR visualization. Subsequently we evaluated post operative continence, defined by the suspension of pads within six months from RARP.


Starting from 10 seconds after the injection of ICG we visualized the arterial structure using near IR fluorescence technology, and progressively we could obtain an optimal highlighting of neurovascular bundles.
This procedure is useful to easily dissect lateral pedicles and control arterial flow and hemostasis, specially for those of us that started robotic surgery only few months ago. We easily identified prostatic arteries and neurovascular bundles using near IR fluorescence technology in all patients (100%). Then, we performed the dissection alternating IR (picture) and non IR view for each patient .
There wasn’t any increase in the operative time compared to RARP without ICG injection performed by the same surgeons. Complications related to injection of ICG did not occurred. In the follow up 24 patients (92.3 %) were continent and two patients (7,7%) were still using pad after six months from surgery.


We use IR green technology to perform meticulous nerve sparing RARP. This expedient helps to improve nerve sparing technique and hemostasis. It let us also to minimize the risk to damage neurovascular bundles, both for experienced robotic surgeon, and for urologists that are just approaching the robotic technology, obtaining a high continence rate within six months after surgery.


In our experience the application of ICG with near IR fluorescence during RARP could be useful in preserving the neurovascular bundle without any complication.