Use of Intra-Operative Indocyanine Green and Firefly ® Technology to Visualize the “Landmark Artery” for Nerve Sparing Robot Assisted Radical Prostatectomy

INTRODUCTION AND OBJECTIVES: The “Landmark Artery” has been shown to be a valuable landmark during nerve sparing radical prostatectomy in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. Our goal was to evaluate an innovative intra-operative tool, Near-infrared (NIR) Firefly technology in conjunction with intravenous indocyanine green (ICG) to help identification of this “Landmark Artery ”during nerve sparing(NS) robot assisted radical prostatectomy(RARP). METHODS: Ten patients underwent nerve sparing RARP. Prior to clamping the pedicle or dissection of the NVB,0.75 cc of ICG was given. The Firefly technology was engaged on the robotic console and a period of 20-40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period we switched back to the non-firefly mode and proceeded with out normal NS operation. Data was collected regarding the % chance of being able to visualize this landmark in the 10 patients. RESULTS: In ten patients 20 NVB were examined with the ICG and Firefly technology. The landmark prostatic artery and its pathway could be identified in 17/20 NVB (85%). In the other 3 patients we were unable to visualize the artery as it was underneath some large veins. The artery was seen visually in these patients during the normal NS surgery. The use of ICG did not significantly increase operative time or result in any immediate or long term complications. CONCLUSIONS: The use of ICG and Firefly technology during NS radical prostatectomy has the potential to more accurately and more frequently identify the landmark prostatic artery that runs along the NVB. For experienced and novice surgeons the pathway of this artery is valuable for NS and can help improve nerve sparing quality