Kanno Toru, Takahashi Toshifumi, Somiya Shinya, Ito Katsuhiro, Higashi Yoshihito, Yamada Hitoshi
Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
J Endourol Case Rep. 2020 Dec 29;6(4):384-387. doi: 10.1089/cren.2020.0123. eCollection 2020.
Intraoperative indocyanine green (ICG) near-infrared fluorescence guidance is a type of optical imaging technology now available to facilitate a better understanding of surgical landmarks. This case describes use of this technique during lower-pole heminephrectomy for a patient with duplex kidney. A 50-year-old woman with a left duplex system and lower-pole kidney infection underwent a laparoscopic transperitoneal lower-pole heminephrectomy. After exposing the left renal pedicles, ICG was administered through a ureteral stent inserted into the upper calix; the nonaffected ureter could be viewed, which enabled us to dissect the affected ureter connected to the lower-pole pelvis. Next, intravenous ICG administration revealed that the lower-pole kidney blood flow was not reduced. This finding prompted us to clamp the main renal artery. Furthermore, ICG injection through a nephrostomy tube helped to observe the lower-pole kidney collecting system and predict the parenchymal dissection plane location between the upper- and lower-pole kidneys. We effectively performed a lower-pole heminephrectomy through complete lower-pole urinary tract resection and maximal upper-pole parenchyma preservation. ICG fluorescence by intravenous and intraureteral administration observes relevant anatomy intraoperatively and is beneficial in patients who undergo a lower-pole heminephrectomy for duplex kidney.
术中吲哚菁绿（ICG）近红外荧光引导是一种现有的光学成像技术，有助于更好地了解手术标志。本病例描述了该技术在双肾盂患者下极半肾切除术中的应用。一名50岁女性，患有左侧双肾盂系统和下极肾感染，接受了腹腔镜经腹下极半肾切除术。暴露左肾蒂后，通过插入上肾盏的输尿管支架注入ICG；可以看到未受影响的输尿管，这使我们能够解剖与下极肾盂相连的受影响输尿管。接下来，静脉注射ICG显示下极肾血流未减少。这一发现促使我们夹闭肾主动脉。此外，通过肾造瘘管注射ICG有助于观察下极肾集合系统，并预测上下极肾之间的实质剥离平面位置。我们通过完整切除下极尿路并最大程度保留上极肾实质，有效地实施了下极半肾切除术。静脉和输尿管内注射ICG荧光可在术中观察相关解剖结构，对因双肾盂行下极半肾切除术的患者有益。
