Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, New York, USA.
J Urol. 2011 Jul;186(1):47-52. doi: 10.1016/j.juro.2011.02.2701. Epub 2011 May 14.
We evaluated the utility of near infrared fluorescence of intravenously injected indocyanine green in performing robotic assisted laparoscopic partial nephrectomy. In addition, we evaluated the initial performance of a novel near infrared fluorescence imaging system integrated into the da Vinci® Si Surgical System during robotic assisted laparoscopic nephrectomy.
Fluorescence imaging for the da Vinci Si Surgical System was used for all cases. Indocyanine green was injected before near infrared imaging. Immediate imaging assessed the renal vasculature while delayed imaging differentiated renal cortical tumors from normal parenchyma. The intraoperative performance of near infrared fluorescence of intravenous indocyanine green was evaluated for tumor appearance relative to surrounding renal parenchyma as well as identification of the renal vasculature.
A total of 11 patients underwent robotic assisted laparoscopic nephrectomy with 2 converted to robotic assisted laparoscopic radical nephrectomy. Indocyanine green injections were repeated up to a total of 5 times depending on the goal of visualization. Of the 11 patients 10 demonstrated malignancy on final pathology. Of the malignant tumors 7 were hypofluorescent and 3 were isofluorescent compared to the surrounding renal parenchyma. Near infrared fluorescence imaging delineated the vascular anatomy in all cases. All surgical margins were negative on final pathology.
Intraoperative imaging of indocyanine green with near infrared fluorescence is a safe and effective method to accurately identify the renal vasculature and to differentiate renal tumors from surrounding normal parenchyma. The capacity for multimodal imaging within the surgical console further facilitates this imaging. Further study is needed to determine if this technique will help improve outcomes of robotic assisted laparoscopic nephrectomy.
我们评估了静脉注射吲哚菁绿近红外荧光在机器人辅助腹腔镜肾部分切除术的应用价值。此外，我们评估了一种新型近红外荧光成像系统在机器人辅助腹腔镜肾切除术中整合到达芬奇® Si 手术系统中的初步性能。
所有病例均使用达芬奇 Si 手术系统的荧光成像。在近红外成像前注射吲哚菁绿。即时成像评估肾血管，而延迟成像则区分肾皮质肿瘤与正常实质。评估静脉注射吲哚菁绿近红外荧光在机器人辅助腹腔镜肾部分切除术中的术中性能，包括肿瘤与周围肾实质的相对外观以及肾血管的识别。
共 11 例患者接受机器人辅助腹腔镜肾切除术，其中 2 例转为机器人辅助腹腔镜根治性肾切除术。根据可视化目标，吲哚菁绿注射重复多达 5 次。11 例患者中，10 例最终病理证实为恶性肿瘤。10 例恶性肿瘤中有 7 例与周围肾实质相比呈低荧光，3 例呈等荧光。近红外荧光成像在所有病例中均能描绘血管解剖结构。所有手术切缘在最终病理检查中均为阴性。
吲哚菁绿的术中近红外荧光成像安全、有效，可准确识别肾血管，区分肿瘤与周围正常实质。手术控制台中的多模态成像能力进一步促进了这种成像。需要进一步研究以确定该技术是否有助于改善机器人辅助腹腔镜肾切除术的结果。
