Second Window Indocyanine Green for Oropharyngeal Tumors: A Retrospective Case Series and Comparison of Near-Infrared Camera Systems

Abstract

Prior studies demonstrated a failure to identify and localize head and neck cancers via near-infrared (NIR) imaging of indocyanine green (ICG) with a robot-integrated platform. However, our group demonstrated success in visualization of neoplasms using a commercially available dedicated NIR camera system and a technique called second window ICG (SWIG), in which ICG is injected 24 hours pre-operatively.• We aimed to evaluate the SWIG technique in patients undergoing transoral robotic surgery (TORS)for oropharyngeal squamous cell carcinoma (OPSCC) and compare two NIR camera systems.• System 1 showed poor tumor-margin delineation with no fluorescence in 4/6 cases (66.7%) and only minimal fluorescence in the remaining 2 cases (33.3%).• System 2 showed marked fluorescence in 5/6 cases (83.3%), with good margin definition in 4 cases (66.7%). In 2 cases (33.3%), System 2 also identified tumor that was not visible under white light. • In this preliminary case series, we found that System 2 outperforms System 1 in NIR imaging with SWIG during TORS for oropharyngeal tumor resection.