Robotic Partial Nephrectomy for Renal Tumors Using Indocyanine Green with Near Infra-red Fluorescence Image: Preliminary Result
Yi-Chia Lin1,2, Chao-Yen Ho1, Te-Fu Tsai1,2, and Thomas I.S. Hwang1,2
Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital
School of Medicine, Fu-Jen Catholic Universtiy
Minimally invasive partial nephrectomy is an alternative of surgical management for small renal mass. Robotic partial nephrectomy has become a popular option. Near infra-red fluorescence image (NIRF) with indocyanine green (ICG) has been described to be useful in robotic partial nephrectomy to delineate the vascular structure and resection margin. We, herein, report our preliminary experience with this technology.
Material and Method:
Six robotic partial nephrectomies (RPNs) were performed with NIRF with ICG. The dosage of injection was 2.5mg as test dose and 5mg before resection and completion of renorrhaphy except for the first case. Transperitoneal approach was employed in 5 cases and retroperitoneal approach in 1 case. The peri-operative parameters were collected.
All 6 RPNs were successfully performed without conversion. The mean operative time was 3.8 (3-5) hours. The warm ischemia time was 26.7 (12-49). No intra-operative complication was noted. ICG was used without side effects and NIRF image was well functioned. The dosesof ICG used in the first case were 1.25mg and 2.5 mg (2 doses) and in the second case were 2.5mg, 5mg and 5mg (3 doses). Renal artery and vein were clearly identified with NIRF with ICG in all 6 cases. The pathological report revealed 4 renal cell carcinoma (RCC), 1 angiomyolipoma (AML) and 1 oncocytoma. The 4 RCCs were not enhanced under NIRF with ICG and other 2 benign tumors were weakly enhanced. The completion dose demonstrated well for the parenchymal perfusion after renorrhaphy.
RPN under NIRF with ICG is useful in identifying the vascular structure and post-renorrhaphy perfusion status. For tumor characteristic and margin status identification, this technology may be possible to provide information. More experience is required for verifying the advantages of the NIRF image with ICG in RPN.