S Gruessner, MD, MBA, F Gheza, MD, A Mangano, MD, LF Gonzalez Ciccarelli, MD, PC Giulianotti, MD. University of Illinois at Chicago
Background/Hypothesis: Indocyanine Green (ICG) has an unquestionable versatility in the field of minimally invasive surgery. We postulate that ICG is an effective alternative to Doppler Ultrasound in assessment of effectiveness of vascular clamping during a heminephrectomy. In this case, we have a 42 year old morbidly obese (BMI 35) male with incidental finding of solid mass in the upper pole of the right kidney by CT.
Materials & methods: the patient underwent a laparoscopic, robotic assisted right heminephrectomy with intraoperative ultrasound for lesion localization and vascular assessment. Due to the high BMI, a complete dissection of the hilum was difficult and risky; we decided to perform a total hilum clamping, instead of our typical arterial dissection and selective clamping. After gaining access to the Kidney, a right renal superior polar branch was discovered and ligated, and the renal pedicle was clamped. We used an injection of 7.5mg ICG peripherally (5mg/mL) to assess total occlusion of the vascular inflow of the kidney, which was impossible to assess in this condition with the doppler probe. Waiting for a clear parenchymal phase, we could confirm the complete absence of flow to the kidney. When the parenchyma was resected using curved harmonic shears, we experienced small back bleeding only, and we could preemptively close the open calyces and secure minor medullary bleeding.
Results: Using ICG, we were visually able to assess successful occlusion of blood supply to the kidney during a difficult heminephrectomy, that in this case was not reliable with the interaoperative Doppler. The patient’s hospital course was uncomplicated, and he was discharged 4 days after the surgery.
Conclusions: ICG is an alternative to Doppler Ultrasound in the assessment of total vascular clamping, when a complete arterial dissection could be difficult. With ICG, there is no need to individually probe each renal segment, particularly when incomplete hilum exposure doesn't allow to detect each single branch. We believe that ICG can be a highly versatile tool in minimally invasive surgery, and its use in this video is just one example of many potential novel applications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95654
Program Number: V100
Presentation Session: Exhibit Hall Theater Video Session IV
Presentation Type: EHVideo