Use of indocyanine green in the resection of renal cysts in children

Abstract

Fluorescent imaging technology with indocyanine green (ICG) is used to improve intraoperative visualization of the anatomical structures of the affected organs and increase the efficiency of laparoscopic or robotic operations. Recently, ICG imaging has been used in pediatric gastroenterology, oncology, and urology.
 In this study, we present laparoscopic treatment of two cases of simple renal cysts in two male patients aged 10 and 12 years. Resection of the extrarenal portion of the kidney cyst was performed using fluoroscopic control by intravenous administration of ICG. The intrarenal residue was subjected to argon-plasma coagulation. Treatment outcomes were assessed over a follow-up period of 6 and 12 months. The cyst sizes measured before surgery using ultrasound and computed tomography were 50 and 70 mm. Both cysts were located in the lower pole of the right kidney. The operation times were 40 and 45 min. During the surgical intervention, no complications such as bleeding from the kidney parenchyma or damage to neighboring organs occurred. In all cases, the cyst contained a clear liquid without pathological impurities. The cytological examination revealed a low cell content, which was represented by single macrophages and urothelial cells. Histological analysis revealed that the lining of the cyst wall was represented by the transitional epithelium without signs of malignancies. The hospital length of stay was 3 days. Ultrasound examinations performed 1, 3, 6, and 12 months after the operation did not detect signs of disease recurrence. Thus, based on the presented clinical case, the main advantage of using fluorescent technology during kidney cyst resection include a clear definition of the demarcation line between the avascular wall of the cyst and the perfused kidney tissue, which helps prevent bleeding from the renal parenchyma.