Introduction
Negative margin status is the most important prognosticator in the surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC), but can be challenging to achieve with tumors in poorly visualized regions.1This can be magnified in transoral robotic surgery (TORS) where haptic feedback is limited. Fluorescence molecular imaging (FMI) using near-infrared (NIR) fluorophores has been increasingly used to augment margin definition and residual tumor detection in vivo for achieving tumor-free margins.
The NIR dye indocyanine green (ICG), routinely used for FMI, accumulates in areas of disrupted, permeable endothelium (i.e. neoplastic tissue) via the enhanced-permeability-and-retention (EPR) effect.2Additionally, ICG accumulates within tumors due to poorly developed tumoral lymphatics.
Recently, TORS has advanced the surgical treatment of OPCSCC.3Unfortunately, prior studies found that ICG failed to identify head and neck lesions and achieve tumor-free margins during TORS.4 Our group previously demonstrated that NIR imaging of ICG injected 24 hours preoperatively, a novel technique called Second Window ICG (SWIG), with the VisionSense IridiumTM platform, could be used for intraoperative identification of head and neck lesions and regional metastasis.5The current study’s objective was to compare a surgical robot-integrated NIR system to a dedicated NIR imaging platform for intraoperative imaging with SWIG.