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- Title
Technical standardization of ICG near-infrared fluorescence (NIRF) laparoscopic partial nephrectomy for duplex kidney in pediatric patients.
- Authors
Esposito, Ciro; Autorino, Giuseppe; Coppola, Vincenzo; Esposito, Giorgia; Paternoster, Mariano; Castagnetti, Marco; Cardone, Roberto; Cerulo, Mariapina; Borgogni, Rachele; Cortese, Giuseppe; Escolino, Maria
- Abstract
Purpose: This study aimed to standardize the operative technique of indocyanine green (ICG) near-infrared fluorescence (NIRF) laparoscopic partial nephrectomy (LPN) and compare it with the standard technique. Methods: In the last 4 years, we performed 22 LPN (14 right-sided, 8 left-sided) in children with non-functioning moiety of duplex kidney. Patients included 12 girls and 10 boys with a median age of 3.9 years (range 1–10). Patients were grouped according to the use of ICG-NIRF: G1 included 12 patients operated using ICG-NIRF and G2 included 10 patients receiving the standard technique. We standardized the technique of injection of ICG in three different steps. Results: The median operative time was significantly lower in G1 [87 min (range 68–110)] compared with G2 [140 min (range 70–220)] (p = 0.001). One intra-operative complication occurred in G2. At post-operative ultrasound (US), the residual moiety was normal in all patients. An asymptomatic renal cyst related to the site of surgery was visualized at US in 8/22 (36%), with a significantly higher incidence in G2 (6/10, 60%) compared with G1 (2/12, 16.6%) (p = 0.001). Renogram demonstrated no loss of function of residual moiety. No allergic reactions to ICG occurred. Conclusion: ICG-NIRF LPN is technically easier, quicker, and safer compared with the standard technique. The main advantages of using ICG-NIRF during LPN are the clear identification of normal ureter, vasculature of non-functioning pole, and demarcation line between the avascular and the perfused pole. The main limitation of ICG technology remains the need for specific laparoscopic equipment that is not always available.
- Subjects
NEPHRECTOMY; CHILD patients; FLUORESCENCE; LAPAROSCOPIC surgery; INDOCYANINE green; STANDARDIZATION
- Publication
World Journal of Urology, 2021, Vol 39, Issue 11, p4167
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-021-03759-6