V399 INTRAOPERATIVE USE OF FLUORESCENCE IMAGING DURING ROBOTIC PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyRenal & Ureter Oncology1 Apr 2012V399 INTRAOPERATIVE USE OF FLUORESCENCE IMAGING DURING ROBOTIC PARTIAL NEPHRECTOMY Nicholas Donin, Cadence Kim, Jason Chiu, and Michael Stifelman Nicholas DoninNicholas Donin New York, NY More articles by this author , Cadence KimCadence Kim New York, NY More articles by this author , Jason ChiuJason Chiu New York, NY More articles by this author , and Michael StifelmanMichael Stifelman New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Indocyanine green (ICG) is an injectable optical agent that generates a fluorescent image when excited by near-infrared laser light. Recently this agent has been used during robotic partial nephrectomy to aid in tumor identification. In this video we demonstrate a novel use for ICG by utilizing it to confirm ischemia to the target area of the kidney when performing selective arterial clamping during partial nephrectomy. METHODS In this video, three patients with renal parenchymal tumors were taken to the operating room for robotic partial nephrectomy. The standard techniques demonstrated previously for robotic partial nephrectomy were employed. After careful dissection of tertiary and quaternary branches of the renal artery and selective clamping, ICG was given to patients intravenously. An upgraded software system and laparoscope for the da Vinci Robot system were used to visualize the renal vessels and renal parenchyma. The performing surgeon then employed and evaluated this technology in demonstrating the location of vessels, effectiveness of clamping, and degree and location of ischemia during partial nephrectomy. RESULTS ICG infusion enabled clear, unequivocal visual confirmation of ischemia to the target area of the kidney containing the tumor. This allowed the operating surgeon to visually confirm ischemia in only the area of the kidney affected by the tumor, while confirming maintained perfusion to the remainder of the uninvolved renal parenchyma. In all cases, effective ischemia allowed for minimal blood loss and good visualization during tumor excision and renorrhaphy while the remainder of the kidney continued to be perfused. CONCLUSIONS Intraoperative fluorescence imaging can be effectively employed for selective arterial clamping. This technology provides real-time, intraoperative feedback regarding the effectiveness of intended ischemia, which allows the operating surgeon to excise the tumor with minimal blood loss and good visualization while the remainder of the kidney is perfused. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e163-e164 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Donin New York, NY More articles by this author Cadence Kim New York, NY More articles by this author Jason Chiu New York, NY More articles by this author Michael Stifelman New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...