Benefits of Intraoperative Fluorescence and Intelligent Insufflation in Hand-Assisted Laparoscopic Nephrectomy in Living Donor: Initial Experience

Abstract

Introduction: The innovative technique of hand-assisted laparoscopic nephrectomy, with smaller incisions and greater versatility for the surgeon, along with an intelligent insufflation system, minimizes intraoperative complications, ischemia time, and postoperative morbidity in the donor. The use of Indocyanine Green (ICG) has revolutionized the visualization of blood vessels and renal parenchyma, providing crucial information about perfusion for transplantation purposes. Case Presentation: Surgery was performed on a 36-year-old male following the complete protocol for left kidney donation. The procedure lasted 06 hours and 15 minutes, with insufflation pressure set at 8 mmHg using an intelligent insufflation system. A total of 17.5 milligrams of ICG were administered in three doses. Indocyanine green filter was used for the dissection of Gerota's fascia, ureter, left adrenal vein, left gonadal vein, renal hilum, and ureteral section. Organ extraction achieved a warm ischemia time of only 03 minutes and 28 seconds. The patient was discharged due to clinical improvement after 48 hours. Follow-up on days 10 and 17 revealed no postoperative complications, pain-free status, and expected laboratory parameter evolution. Conclusion: The integration of indocyanine green with the technique of hand-assisted laparoscopic nephrectomy using an intelligent insufflation system proves to be a promising approach, allowing clear identification of anatomical elements and facilitating surgery. This approach not only reduces transoperative risks but also decreases hospitalization time and postoperative morbidity, setting a new standard in renal surgical practice.