Use of Intraoperative Indocyanine Green to Facilitate Robot-Assisted Laparoscopic Upper Pole Partial Nephroureterectomy

Abstract

Abstract Introduction: During partial nephrectomy, identifying and occluding the appropriate segmental vessels that supply the diseased parenchyma before resection are critical to minimizing blood loss. While it is sometimes possible to identify vascular changes visually, the presence of complicated renal vascular anatomy may complicate appropriate identification of polar vessels. We now report the use of near-infrared fluorescence (NIRF) with intravenous indocyanine green (ICG) to confirm appropriate vascular occlusion before parenchymal resection during a robot-assisted laparoscopic partial nephroureterectomy. Materials and Methods: A left robot-assisted laparoscopic upper pole partial nephroureterectomy was performed for an obstructed, minimally functional left upper pole moiety in the setting of persistent left flank pain using the da Vinci Si System. The patient was positioned, prepped, draped, and trocars placed in the typical manner. The colon was reflected medially. A complex renal hilum was ident...