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VR-32
(VS)
SELECTIVE ARTERIAL MAPPING USING NEAR INFRARED FLUORESCENCE
IMAGING IN PEDIATRIC ROBOT ASSISTED LAPAROSCOPIC HEMINEPHRECTOMY
Christina CHING, Daniel DAJUSTA, Seth ALPERT, Daryl MCLEOD and Daniel HERZ
Nationwide Children's Hospital, Urology, Columbus, USA
PURPOSE
Selective arterial mapping (SAM) using near-infrared fluorescence (NIRF) imaging with administration of Indocyanine
green (ICG) is used during robot partial nephrectomy to determine regional renal perfusion. We hypothesize that SAM
may prevent vascular complications in pediatric robotic laparoscopic heminephrectomy (RALHN) by determining or
confirming the area of excision. This purpose of this video is to demonstrate this novel technique.
MATERIAL AND METHODS
We have performed SAM in 5 RALHNs. In each, 0.5 to 1 ml of ICG was infused after soft bulldog occlusion of a candidate
segmental renal artery. After 60 seconds, NIRF imaging was used to determine regional perfusion deficit. This video
depicts one of the 5 cases.
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). This video shows the case of a
4 y/o female who presented continuous urinary incontinence secondary to a duplex right kidney with an ectopic upper
pole ureter.
CONCLUSIONS
In pediatric RALHN, SAM was feasible and safe, and provided real-time intraoperative confirmation of selective ischemia
in the moiety to be excised, and safely guided arterial ligation in complex duplex renal anatomy. The patient from the
video did well and her incontinence resolved after surgery.