ArticleUpdates in surgery2026
Indocyanine green (ICG) fluorescence in laparoscopic adrenalectomy: categorization of adrenal tumors relative to normal adrenal gland.
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
ICG-fluorescent guided laparoscopic adrenalectomy (LA) has recently been adopted by endocrine surgeons but is still in its infancy. Consequentially, the optimal use of it in imaging different tumors is yet to be defined. All patients undergoing ICG-fluorescent guided LA in our department, from June 2020 until May 2024, were included in this study. Administration of 5mg of ICG was executed in 2 stages, before and after dissection of the anatomic plane of the adrenal gland. Adrenal tumors were categorized according to their fluorescent properties when compared to normal adrenal gland as "hyperfluorescent" or "hypofluorescent". Patient demographics, indication for surgery, tumor size, operative time and intraoperative complications were measured. This study included 61 patients undergoing LA, 31 being left LA and 30 right LA. Indications for surgery included aldosteronoma, pheochromocytoma, cushing syndrome, non-secreting adrenal tumors, myelolipoma, metastasis and possible carcinoma. Mean operative time was 124 ± 24 min, mean dose of ICG injected was 10 mg (range 10-15 mg). Adrenal tumors were categorized as hyperfluorescent in 24 (39.4%) and hypofluorescent in 37 (60.6%) cases when compared to normal adrenal gland. Pheochromocytomas appeared hypofluorescent in 12/15 (80%) of cases while tumors of cortical origin were hypofluorescent in 21/38 (55%) of cases compared to normal adrenal gland. Adrenal tumors exhibit different levels of fluorescent intensity according to their origin. Pheochromocytomas appear hypofluorescent in 80% of the cases, a finding that may assist surgeons when performing cortical sparing LAs addressing pheochromocytomas.
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