Near-Infrared Fluorescence Imaging Can Help Identify the Contralateral Phrenic Nerve During Robotic Thymectomy

• Published in: The Annals of thoracic surgery Vol. 94; no. 2; pp. 622 - 625
• Main Authors: Wagner, Oliver J., MD, Louie, Brian E., MD, Vallières, Eric, MD, Aye, Ralph W., MD, Farivar, Alexander S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coloring Agents; Female; Fluorescence; Humans; Indocyanine Green; Infrared Rays; Male; Medical sciences; Middle Aged; Phrenic Nerve - anatomy & histology; Pneumology; Robotics; Surgery; Thymectomy - methods; Young Adult; 13; Thymectomy; Treatment; Contralateral; Phrenic nerve; Surgery; Fluorescence; Anesthesia; Medical imagery; Circulatory system; Cardiology; Robotics
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.04.119

Purpose Unilateral robotic thymectomy is gaining popularity. Identifying the contralateral phrenic nerve is a key limitation to achieving maximal thymic tissue resection. We evaluated the feasibility and technique of fluorescence imaging on the daVinci-Si robot (Intuitive Surgical Inc, Sunnyvale, CA) to identify the contralateral periocardiophrenic neurovascular bundle (PNB). Description A unilateral right robotic thymectomy was performed in 10 patients. The thymus and its poles were mobilized. Indocyanine green was injected and fluoresced to identify the left PNB in four different viewing angles to assess the view that consistently positively identified the PNB. Evaluation No complications from indocyanine green or injuries to the phrenic nerve occurred. The contralateral PNB was visualized in 80% of patients from a left pleural view, infrequently from a mediastinal view, and never distal to the aortopulmonary window. Conclusions During right robotic thymectomy, fluorescence imaging facilitates identification of the contralateral phrenic nerve by fluorescing the pericardiophrenic vessels. It is best visualized from a left pleural view. This technology has the potential to maximize thymic tissue resection with a unilateral approach while reducing operative time and nerve injury.