Small Intestinal Masses and Robotic-Assisted Removal Using ICG

Small intestinal masses encompass a range of benign and malignant conditions, including gastrointestinal stromal tumors (GISTs), adenocarcinomas, neuroendocrine tumors, and metastatic lesions. The robotic platform provides an ideal approach for the surgical management of these lesions due to its enhanced visualization, dexterity, and precision in confined spaces.

Robotic surgery enables precise dissection around critical structures, particularly the mesenteric vasculature, which supplies the small intestine. The integration of indocyanine green (ICG) fluorescence imaging has revolutionized intraoperative decision-making. Administered intravenously, ICG binds to plasma proteins and fluoresces under near-infrared light, allowing real-time visualization of blood flow. This ensures the preservation of mesenteric perfusion, reduces the risk of ischemia, and optimizes bowel resection margins.

For oncological resections, robotic platforms allow meticulous lymphadenectomy. This is especially crucial in malignancies like neuroendocrine tumors and adenocarcinomas, where lymph node harvesting directly impacts staging and long-term outcomes. The precision of robotic instruments facilitates thorough lymph node dissection with minimal collateral damage to adjacent structures.

The robotic system also allows minimally invasive handling of small intestinal masses that would be challenging to access laparoscopically due to their deep intraperitoneal location or proximity to major vessels. The magnified 3D view provided by robotic systems aids in identifying small tumors, minimizing tissue trauma, and achieving R0 resections with oncologically sound margins.

Studies suggest that the use of ICG during robotic-assisted surgery can reduce complications, such as anastomotic leaks and vascular compromise, by providing an additional layer of safety in assessing tissue viability. Furthermore, reduced blood loss and shorter recovery times align with the principles of enhanced recovery after surgery (ERAS).