Use of indocyanine green fluorescence imaging to determine the area of ileum with poor blood flow during robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

Abstract

Introduction: The utility of Firefly mode, a technology using near-infrared imaging, used with the intravenous injection of indocyanine green, and which is available as an optional feature for the Da Vinci surgical platform has recently been explored. We herein describe a case in which we detected the ileum with inadequate blood flow using Firefly mode during the processing of the robot-assisted radical cystectomy with intracorporeal urinary diversion. Presentation of the case: A 75-year-old woman diagnosed as having invasive bladder cancer underwent robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion using a Da Vinci Xi surgical system. We used Firefly mode after injection of indocyanine green during the processing of the intracorporeal digestive restoration, which resulted in providing intraoperative visual assessment of blood flow to the ileum, allowing us to detect intestine with inadequate blood flow which was not so obvious under the normal visible light mode. We resected the ileum with poor blood flow and reanastomosed the residual small bowel. The patient was released from the hospital only with minor complications. Conclusion: Firefly mode, used with indocyanine green has a potential to be a useful tool that may facilitate robotic surgery including robot-assisted radical cystectomy with intracorporeal urinary diversion. Level of evidence: 5 (case report)