Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus

Giovanni E. Cacciamani, A. Shakir, A. Tafuri, K. Gill, J. Han, N. Ahmadi, P. A. Hueber, M. Gallucci, G. Simone, R. Campi, G. Vignolini, W. C. Huang, J. Taylor, E. Becher, F. W.B. Van Leeuwen, H. G. Van Der Poel, L. P. Velet, A. K. Hemal, A. Breda, R. AutorinoR. Sotelo, M. Aron, M. M. Desai, A. L. De Castro Abreu

Research output: Contribution to journalArticlepeer-review


Purpose: The aim of the present study is to investigate the impact of the near-infrared (NIRF) technology with indocyanine green (ICG) in robotic urologic surgery by performing a systematic literature review and to provide evidence-based expert recommendations on best practices in this field. Methods: All English language publications on NIRF/ICG-guided robotic urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus® and Web of Science™ databases (up to April 2019). Experts in the field provided detailed pictures and intraoperative video-clips of different NIRF/ICG-guided robotic surgeries with recommendations for each procedure. A unique QRcode was generated and linked to each underlying video-clip. This new exclusive feature makes the present the first “dynamic paper” that merges text and figure description with their own video providing readers an innovative, immersive, high-quality and user-friendly experience. Results: Our electronic search identified a total of 576 papers. Of these, 36 studies included in the present systematic review reporting the use of NIRF/ICG in robotic partial nephrectomy (n = 13), robotic radical prostatectomy and lymphadenectomy (n = 7), robotic ureteral re-implantation and reconstruction (n = 5), robotic adrenalectomy (n = 4), robotic radical cystectomy (n = 3), penectomy and robotic inguinal lymphadenectomy (n = 2), robotic simple prostatectomy (n = 1), robotic kidney transplantation (n = 1) and robotic sacrocolpopexy (n = 1). Conclusion: NIRF/ICG technology has now emerged as a safe, feasible and useful tool that may facilitate urologic robotic surgery. It has been shown to improve the identification of key anatomical landmarks and pathological structures for oncological and non-oncological procedures. Level of evidence is predominantly low. Larger series with longer follow-up are needed, especially in assessing the quality of the nodal dissection and the feasibility of the identification of sentinel nodes and the impact of these novel technologies on long-term oncological and functional outcomes.

Original languageEnglish
JournalWorld Journal of Urology
Publication statusAccepted/In press - Jan 1 2019


  • Firefly: robotic surgery
  • ICG
  • Indocyanine green
  • Lymphadenectomy
  • Near-infrared fluorescence
  • NIRF
  • Robotic adrenalectomy
  • Robotic partial nephrectomy
  • Robotic radical cystectomy
  • Robotic radical prostatectomy
  • Urology

ASJC Scopus subject areas

  • Urology


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