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Vol. 40. Issue 3.
Pages 190-194 (April 2016)
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Vol. 40. Issue 3.
Pages 190-194 (April 2016)
Skill and talent
Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy
Uso de la fluorescencia cercana al infrarrojo en nefrectomía parcial laparoscópica asistida por robot
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V. Cornejo-Dávilaa,
Corresponding author
cornejomd@gmail.com

Corresponding author.
, M. Nazmy Jr.b, N. Kellac, M.A. Palmeros-Rodrígueza, J.G. Morales-Montora, C. Pacheco-Gahblera
a División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., Mexico
b The Urology and Prostate Institute, San Antonio, TX, United States
c The Urology Place, San Antonio, TX, United States
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Abstract
Background

Partial nephrectomy is the treatment of choice for T1a tumors. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence.

Objective

To demonstrate the implementation of fluorescence in nephron-sparing surgery.

Case report

This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumor measuring 31mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischemia time of 22min and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumor was a pT1aN0M0 renal cell carcinoma, with negative margins.

Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischemia time.

Conclusion

Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumor resection and can potentially improve the oncological and functional results.

Keywords:
Robot-assisted partial nephrectomy
Near-infrared fluorescence imaging
Intraoperative ultrasound
Renal cancer
Resumen
Antecedentes

La nefrectomía parcial es el tratamiento de elección para tumores T1a, siendo el abordaje abierto aún el estándar. La cirugía laparoscópica asistida por robot ofrece ventajas aplicables a la nefrectomía parcial como el uso del sistema Firefly® con fluorescencia cercana al infrarrojo.

Objetivo

Mostrar la aplicación de la fluorescencia en una cirugía preservadora de nefronas.

Caso clínico

Mujer de 37 años, fumadora, con obesidad. Tumor renal derecho de 31mm como hallazgo en tomografía por lo que es sometida a nefrectomía parcial laparoscópica asistida por robot, con tiempo de isquemia caliente de 22 minutos y uso de fluorescencia con sistema Firefly® para guiar la resección, sin complicaciones, con carcinoma de células renales pT1aN0M0, márgenes negativos.

La cirugía renal laparoscópica asistida por robot se emplea para cirugía preservadora de nefronas, con buenos resultados oncológicos y funcionales. La combinación de la tecnología Firefly® con el ultrasonido transoperatorio puede delimitar con mayor precisión la extensión de la lesión, pudiendo aumentar los márgenes negativos y disminuir el tiempo de isquemia.

Conclusión

La fluorescencia cercana al infrarrojo en la nefrectomía parcial asistida por robot es útil para guiar la resección del tumor y potencialmente poder mejorar los resultados oncológicos y funcionales.

Palabras clave:
Nefrectomía parcial robótica
Fluorescencia, infrarrojo
Ultrasonido intraoperatorio
Cáncer renal

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