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S20-3
(PP)
SELECTIVE ARTERIAL MAPPING USING NEAR INFRARED FLUORESCENCE
IMAGING IN PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC HEMINEPHRECTOMY
Christina CHING, Daniel HERZ, Daniel DAJUSTA, Daryl MCLEOD and Meghan SCHOBER
Nationwide Children's Hospital, Pediatric Urology, Columbus, USA
PURPOSE
Selective arterial mapping (SAM) using near-infrared fluorescence (NIRF) imaging with IV administration of Indocyanine
green (ICG) is used during robot partial nephrectomy to determine regional renal perfusion. Injury to the innocent
moiety in pediatric heminephrectomy occurs in ~ 4-5% of cases. We hypothesize that SAM may prevent vascular
complications in pediatric robotic laparoscopic heminephrectomy (RALHN) by determining or confirming the area of
excision. Our objective was to provide clinical outcomes of SAM in pediatric RALHN.
MATERIAL AND METHODS
We have performed SAM in 5 RALHNs using NIRF. In each case, 0.5 to 1 ml of ICG was infused IV after soft bulldog
occlusion of a candidate segmental renal artery. After 60 seconds, NIRF imaging was used to determine the regional
perfusion deficit. Heminephrectomy was completed when ischemia was confirmed. Patient characteristics, perioperative
outcomes, and complications were analyzed. Post-operative ultrasound at 6 weeks was used to determine innocent
moiety integrity.
RESULTS
SAM was completed successfully in all 5 children. There were no complications or adverse reactions associated with IV
ICG. There were 3 males and 2 females. The mean age was 5.4 years (2.2 to 10 years). Diagnosis was duplex
ureterocele (n=3) and duplex ectopic ureter (n=2). Average pre-operative excised moiety function was 4% (0-9%). In 3
of 5 cases, SAM confirmed the candidate vessel(s) perfusing the moiety to be excised. In 2 cases SAM guided additional
arterial ligation, and an alternative dissection and moiety removal than that suspected by dissection alone. This study is
limited by the lack of a comparative cohort.
CONCLUSIONS
In pediatric RALHN, SAM was feasible and safe, and provided real-time intraoperative confirmation of selective ischemia
in the moiety to be excised. SAM also safely guided arterial ligation in complex duplex renal anatomy. Long term studies
with a matched cohort are needed.