The safety and technical feasibility of indocyanine green (ICG) fluorescence imaging for evaluating organs vascularization and tissues perfusion have been demonstrated in gastrointestinal and hepatopancreatobiliary surgery. In the field of pancreatic surgery, the usefulness of intraoperative fluorescence imaging using ICG has been shown for assessing splenic perfusion following spleen-preserving distal pancreatectomy (SPDP). Furthermore, recent development of robotic surgery enables to use ICG fluorescence easier, providing additional advantages such as accurate recognition of primary lesion, anatomical structures, and resection margins. However, to date, there has been no study reporting the technical feasibility of ICG fluorescence during robotic SPDP. Moreover, no study has investigated hemodynamics of the spleen in robotic SPDP with the splenic vessel-sacrificing approach (the Warshaw technique) and with the splenic vessel-preserving approach (the Kimura technique). Herein, we present our experiences of ICG fluorescence imaging in robotic SPDP.

In conclusion, we confirmed splenic perfusion with ICG fluorescence imaging in two main approaches of SPDP with the Warshaw situation as well as the Kimura situation. To our best knowledge, this is the first video article demonstrating ICG fluorescence imaging in robotic SPDP. ICG fluorescence imaging in robotic SPDP is easy and feasible to evaluate the splenic perfusion, therefore should be performed as a standard clinical practice.

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