Fluorescence-Guided Minimally-Invasive Resection of Abdominal Paragangliomas using Indocyanine Green

Abstract

Abstract This 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, rare neuroendocrine tumors often challenging to detect during surgery. Due to their anatomical location, often small size, and the similar appearance of the lesions in regard to their surrounding tissue. Minimally-invasive resections were planned for patients with suspected abdominal paragangliomas, who received a single bolus of 5mg ICG after abdominal exploration. NIR fluorescence imaging of the suspected abdominal region of the suspected lesion immediately followed administration, assessing fluorescence signals, intraoperative identification, and correlation with histopathology. Among five suspect lesions resected, four were imaged with NIR fluorescence, with pathology confirming four as paragangliomas and one as an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30-60 seconds post-ICG, enduring up to 30 minutes. 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.