title: Near infrared fluorescence imaging with robotic assisted laparoscopic partial nephrectomy: initial clinical experience for renal cortical tumors.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Tobis
authors.forename: Joy
authors.initials: J
authors.lastname: Knopf
authors.forename: Christopher
authors.initials: C
authors.lastname: Silvers
authors.forename: Jorge
authors.initials: J
authors.lastname: Yao
authors.forename: Hani
authors.initials: H
authors.lastname: Rashid
authors.forename: Guan
authors.initials: G
authors.lastname: Wu
authors.forename: Dragan
authors.initials: D
authors.lastname: Golijanin
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007259:Infrared Rays; D007275:Injections, Intravenous; D007680:Kidney Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green