Using ICG navigation in resection of a horseshoe kidney

Abstract

BACKGROUND: In this publication, we present a new area of application of indocyanine green (ICG) imaging in pediatric surgery. We used this advanced method to evaluate the resection margins of a functional segment of the horseshoe kidney after intravenous indocyanine green.

CLINICAL CASE DESCRIPTION: The article presents a case of treatment of a horseshoe kidney complicated by vesicorenal reflux in the left segment and loss of function of the left segment. Resection of the left half of the horseshoe kidney was performed using fluoroscopic control with intravenous administration of indocyanine green. The surgery was performed using the RUBINA™ endovideosurgical system manufactured by KARL STORZ (Germany). RUBINA™ components offer a variety of ICG in near-infrared fluorescence signal imaging modes. Depending on the surgeon and the application, ICG in near-infrared fluorescence data can be used in different modes: image overlay mode, backup mode, color mapping mode. After confirming the boundaries of the perfused part of the kidney, laparoscopic resection of the functional half was performed at the level of the isthmus.

The use of ICG imaging was very important in identifying healthy tissue that stained intensely green 2 minutes after intravenous indocyanine green administration. This margin check verifies the functioning renal parenchyma and allows the correct selection of the nephrectomy margin. The next day after the operation, an ultrasound examination of the renal remnant and perinephric space was performed — the rotation to the right hour of the horseshoe-shaped kidney was good and no accumulation of fluid was detected in the bed of the removed segment. A control ultrasound examination 6 months after the operation showed the preservation of the parenchyma of the right half of the kidney, which indicates the positive effect of the surgical procedure.

CONCLUSION: ICG navigation is a promising method for noninvasive assessment of resection margins in patients with horseshoe kidneys.

Keywords

horseshoe kidney / ICG navigation / indocyanine green / laparoscopy / children

References

[1] Esposito C, Escolino M, Corcione F, et al. Twenty-year experience with laparoscopic and retroperitoneoscopic nephrectomy in children: Considerations and details of technique. Surg Endosc. 2016;30(5):2114-2118. EDN: VHFWSE doi: 10.1007/s00464-015-4472-7

[2] Esposito C., Escolino M., Corcione F., et al. Twenty-year experience with laparoscopic and retroperitoneoscopic nephrectomy in children: Considerations and details of technique // Surg Endosc. 2016. Vol. 30, N 5. P. 2114-2118. EDN: VHFWSE doi: 10.1007/s00464-015-4472-7

[3] Esposito C, Varlet F, Patkowski D, et al. Laparoscopic partial nephrectomy in duplex kidneys in infants and children: Results of an European multicentric survey. Surg Endosc. 2015;29(12):3469-3476. EDN: ROPPUI doi: 10.1007/s00464-015-4096-y

[4] Esposito C., Varlet F., Patkowski D., et al. Laparoscopic partial nephrectomy in duplex kidneys in infants and children: Results of an European multicentric survey // Surg Endosc. 2015. Vol. 29, N 12. P. 3469-3476. EDN: ROPPUI doi: 10.1007/s00464-015-4096-y

[5] Esposito C, Autorino G, Coppola V, et al. Technical standardization of ICG near-infrared fluorescence (NIRF) laparoscopic partial nephrectomy for duplex kidney in pediatric patients. World J Urol. 2021;39(11):4167-4173. EDN: BCDYBJ doi: 10.1007/s00345-021-03759-6

[6] Esposito C., Autorino G., Coppola V., et al. Technical standardization of ICG near-infrared fluorescence (NIRF) laparoscopic partial nephrectomy for duplex kidney in pediatric patients // World J Urol. 2021. Vol. 39, N 11. P. 4167-4173. EDN: BCDYBJ doi: 10.1007/s00345-021-03759-6

[7] Ferroni MC, Sentell K, Abaza R. Current role and indications for the use of indocyanine green in robot-assisted urologic surgery. Eur Urol Focus. 2018;4(5):648-651. doi: 10.1016/j.euf.2018.07.009

[8] Ferroni M.C., Sentell K., Abaza R. Current role and indications for the use of indocyanine green in robot-assisted urologic surgery // Eur Urol Focus. 2018. Vol. 4, N 5. P. 648-651. doi: 10.1016/j.euf.2018.07.009

[9] Ebert B, Riefke B, Sukowski U, Licha K. Cyanine dyes as contrast agents for near-infrared imaging in vivo: Acute tolerance, pharmacokinetics, and fluorescence imaging. J Biomed Opt. 2011;16(6):066003. doi: 10.1117/1.3585678

[10] Ebert B., Riefke B., Sukowski U., Licha K. Cyanine dyes as contrast agents for near-infrared imaging in vivo: Acute tolerance, pharmacokinetics, and fluorescence imaging // J Biomed Opt. 2011. Vol. 16, N 6. P. 066003. doi: 10.1117/1.3585678

[11] Paraboschi I, De Coppi P, Stoyanov D, et al. Fluorescence imaging in pediatric surgery: State-of-the-art and future perspectives. J Pediatr Surg. 2021;56(4):655-662. doi: 10.1016/j.jpedsurg.2020.08.004

[12] Paraboschi I., De Coppi P., Stoyanov D., et al. Fluorescence imaging in pediatric surgery: State-of-the-art and future perspectives // J Pediatr Surg. 2021. Vol. 56, N 4. P. 655-662. doi: 10.1016/j.jpedsurg.2020.08.004

[13] Alghoul H, Farajat FA, Alser O, et al. Intraoperative uses of near-infrared fluorescence spectroscopy in pediatric surgery: A systematic review. J Pediatr Surg. 2022;57(6):1137-1144. EDN: AFWUPL doi: 10.1016/j.jpedsurg.2022.01.039

[14] Alghoul H., Farajat F.A., Alser O., et al. Intraoperative uses of near-infrared fluorescence spectroscopy in pediatric surgery: A systematic review // J Pediatr Surg. 2022. Vol. 57, N 6. P. 1137-1144. EDN: AFWUPL doi: 10.1016/j.jpedsurg.2022.01.039

[15] Bjurlin MA, McClintock TR, Stifelman MD. Near-infrared fluorescence imaging with intraoperative administration of indocyanine green for robotic partial nephrectomy. Curr Urol Rep. 2015;16(4):20. EDN: NRUQPC doi: 10.1007/s11934-015-0495-9

[16] Bjurlin M.A., McClintock T.R., Stifelman M.D. Near-infrared fluorescence imaging with intraoperative administration of indocyanine green for robotic partial nephrectomy // Curr Urol Rep. 2015. Vol. 16, N 4. P. 20. EDN: NRUQPC doi: 10.1007/s11934-015-0495-9

[17] Harke N, Schoen G, Schiefelbein F, Heinrich E. Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: A single-surgeon matched-pair study. World J Urol. 2014;32(5):1259-1265. EDN: RZKQLW doi: 10.1007/s00345-013-1202-4

[18] Harke N., Schoen G., Schiefelbein F., Heinrich E. Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: A single-surgeon matched-pair study // World J Urol. 2014. Vol. 32, N 5. P. 1259-1265. EDN: RZKQLW doi: 10.1007/s00345-013-1202-4

[19] Angell JE, Khemees TA, Abaza R. Optimization of near infrared fluorescence tumor localization during robotic partial nephrectomy. J Urol. 2013;190(5):1668-1673. doi: 10.1016/j.juro.2013.04.072

[20] Angell J.E., Khemees T.A., Abaza R. Optimization of near infrared fluorescence tumor localization during robotic partial nephrectomy // J Urol. 2013. Vol. 190, N 5. P. 1668-1673. doi: 10.1016/j.juro.2013.04.072

[21] Pathak RA, Hemal AK. Intraoperative ICG-fluorescence imaging for robotic-assisted urologic surgery: Current status and review of literature. Int Urol Nephrol. 2019;51(5):765-771. EDN: WUATRX doi: 10.1007/s11255-019-02126-0

[22] Pathak R.A., Hemal A.K. Intraoperative ICG-fluorescence imaging for robotic-assisted urologic surgery: Current status and review of literature // Int Urol Nephrol. 2019. Vol. 51, N 5. P. 765-771. EDN: WUATRX doi: 10.1007/s11255-019-02126-0

[23] Arora S, Rogers C. Partial nephrectomy in central renal tumors. J Endourol. 2018;32(1):S63-S67. EDN: YHASHZ doi: 10.1089/end.2018.0046

[24] Arora S., Rogers C. Partial nephrectomy in central renal tumors // J Endourol. 2018. Vol. 32, N 1. P. S63-S67. EDN: YHASHZ doi: 10.1089/end.2018.0046

[25] Manny TB, Krane LS, Hemal AK. Indocyanine green cannot predict malignancy in partial nephrectomy: Histopathologic correlation with fluorescence pattern in 100 patients. J Endourol. 2013;27(7):918-921. doi: 10.1089/end.2012.0756

[26] Manny T.B., Krane L.S., Hemal A.K. Indocyanine green cannot predict malignancy in partial nephrectomy: Histopathologic correlation with fluorescence pattern in 100 patients // J Endourol. 2013. Vol. 27, N 7. P. 918-921. doi: 10.1089/end.2012.0756

[27] Borofsky MS, Gill IS, Hemal AK, et al. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy. BJU Int. 2013;111(4):604-610. doi: 10.1111/j.1464-410X.2012.11490.x

[28] Borofsky M.S., Gill I.S., Hemal A.K., et al. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy // BJU Int. 2013. Vol. 111, N 4. P. 604-610. doi: 10.1111/j.1464-410X.2012.11490.x

[29] Esposito C, Escolino M, Troncoso Solar B, et al. Diagnosis and long-term outcome of renal cysts after laparoscopic partial nephrectomy in children. BJU Int. 2017;119(5):761-766. doi: 10.1111/bju.13698

[30] Esposito C., Escolino M., Troncoso Solar B., et al. Diagnosis and long-term outcome of renal cysts after laparoscopic partial nephrectomy in children // BJU Int. 2017. Vol. 119, N 5. P. 761-766. doi: 10.1111/bju.13698

RIGHTS & PERMISSIONS

Eco-Vector