Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 657-662. doi: 10.19723/j.issn.1671-167X.2020.04.011

Previous Articles     Next Articles

Usefulness of the indocyanine green fluorescence imaging technique in laparoscopic partial nephrectomy

Shu-dong ZHANG1,Peng HONG1,Bin-shuai WANG1,Shao-hui DENG1,Fan ZHANG1,Li-yuan TAO2,Cai-guang CAO3,Zhen-hua HU3,Lu-lin MA1,△()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Clinical Research Center of Epidemiology, Peking University Third Hospital, Beijing 100191, China
    3. Chinese Academy of Sciences Automation Research Institute,Chinese Academy of Sciences Key Laboratory of Molecular Imaging, Beijing 100190, China
  • Received:2020-03-15 Online:2020-08-18 Published:2020-08-06
  • Contact: Lu-lin MA E-mail:malulin@medmail.com.cn
  • Supported by:
    Peking University Third Hospital Clinical Cohort Study(BYSYDL2019010)

RICH HTML

 26   

PDF (PC)

499

Abstract:

Objective: To detail a novel technique for marking renal tumors with intravenous indocyanine green (ICG) during laparoscopic partial nephrectomy, and to investigate the feasibility and safety of this technique with the use of near-infrared fluorescence imaging. Methods: Between July 2019 and January 2020, 25 consecutive cases with renal masses underwent intraoperative ICG tumor marking laparoscopic partial nephrectomy, at the department of urology in Peking University Third Hospital by the same surgeon. The key benefits included quick intraoperative identification of the mass with improved visualization and real-time control of resection margins by the ICG Immunofluorescence imaging technique. Clinical data were prospectively collected in our institutional database. Perioperative, pathological, and clinical outcomes of the partial nephrectomy were assessed. Measurement data with normal distribution and count data were respectively described as M(range) and percentage. Among these cases, 16 cases were male and 9 cases female , The median body mass index was 25.4 (20.0-35.4) kg/m2. The average age was 54 (29-77) years. The maximum tumor diameter was 2.75(1.30-5.20) cm. The R.E.N.A.L score was 7.5 (5.0-10.0).The tumor locations were distributed with upper pole (11, 42%), middle (6, 23%), and lower pole (9, 35%).The clinical stages of the tumor were described as follows: T1aN0M0 (23, 88.5%),T1bN0M0(2, 7.7%),T2aN0M0 (1, 3.8%). Results: All the 25 cases were performed 26 times with intraoperative ICG tumor marking laparoscopic partial nephrectomy. There were no allergy,infection and other complications with intravenous indocyanine green. The surgical procedure was successful in all the patients. No conversion and blood transfusion were needed. All the cases of the surgical margin were negative. Overall the operative time was 136 (50-247) min and warm ischemia time was 14 (7-30) min.The estimated blood loss was 50 (10-400) mL and the hospital stay was 5.5 (3.0-31.0) days. One case with perirenal hematoma, one case with urine leak, one with respiratory failure and deep venous thrombosis. All of these cases were cured by the corresponding treatment. The others had no severe complications. There was no tumor recurrence and metastasis during the follow up with 4 to 10 months. Conclusion: ICG marking and near-infrared fluorescence imaging technology has now emerged as a safe, feasible and useful tool that may facilitate laparoscopic partial nephrectomy.

Key words: Indocyanine green, Partial nephrectomy, fluorescence, Laparoscopy

CLC Number: 

  • R737.11

Table 1

Baseline and clinical data"

Variable Value
Patients, n 25
Age/year, M (range) 54 (29-77)
BMI/(kg/m2), M (range) 25.4 (20.0-35.4)
Gender, n
Male 19
Female 6
Number of tumor 26
Affected side, n
Left 12
Right 14
Tumor distribution, n
Ventral 20
Dorsal 3
Ventral and dorsal 3
Tumor location, n
Upper 11
Middle 6
Lower 9
Previous abdominal surgery, n 8
Maximum diameter of tumor/cm, M (range) 2.75 (1.30-5.20)
Preoperative creatinine/(μmol/L), M (range) 78 (54-126)
Postoperative creatinine/(μmol/L), M (range) 87.5 (49.0-149.0)
ASA score, n
1 7
2 19
R.E.N.A.L score, M (range) 7.5 (5.0-10.0)
3S+f score, M (range) 7 (5-11)
Surgical approach, n
Transperitoneal 4
Retroperitoneal 22
Intraoperative ultrasonography, n 8
Tumor morphological character, n
Cystic 2
Solid 21
Solid and cystic 3

Figure 1

Resection of irregular shape of renal tumor A, CT scan showing irregular shape of renal tumor,majority of tumor located in renal parenchyma; B, tumor showing by general white light; C, boun-dary between tumor and normal parenchyma by pseudo color mode showing after injected ICG; D, multiple mode showing the renal tumor including the white light, fluorescence, pseudo color mode from up to down, the vessel around the tumor was clearly recognized by the arrow; E, relation between base and collect system showing by real-time fluorescence; F, specimen of resected tumor with negative surgical margin."

Figure 2

Satellite lesion showing by the fluorescence after resection of the tumor A, difficult identification between tumor and normal parenchyma by white light mode; B, boundary between tumor and normal parenchyma by fluorescence mode showing after injected ICG; C, preparation of renal parenchyma resection by real-time fluorescence; D, multiple mode showing the satellite lesion including the fluorescence, original fluorescence, pseudo color mode from up to down, the satellite lesion was clearly recognized after tumor resection, showing by the arrow."

Figure 3

Resection of totally endophytic renal tumor A, fluorescence imaging on the renal surface with totally endophytic renal tumor; B, no dying of endophytic renal tumor and identification of basal vessel; C, fat of renal sinus showing in the base,suggested the tumor was completely resected; D, tumor showing by general white light; E, tumor showing by fluorescence imaging,capsule was intact; F, sutured defect showing by fluorescence imaging."

Table 2

Perioperative and pathological data"

Items Values
Pathology type, n
Clear cell RCC 21
Papillary RCC 3
Renal oncocytoma 2
Pathologic stage, n
T1a 21
T1b 2
T3a 3
WHO/ISUP classification, n
Ⅰ 3
Ⅱ 13
Ⅲ 8
Involvement of renal capsule, n 1
Involvement of perirenal fat, n 1
Involvement of renal sinus or pelvis, n 2
Overall operative time/min, M(range) 136 (50-247)
WIT/min, M(range) 14 (7-30)
Estimated blood loss/mL, M (range) 50 (10-400)
LOS/d, M (range) 5.5 (3.0-31.0)
Postoperative complications, n
Perirenal hematoma 1
Urine leak 1
Respiratory failure and DVT 1

Table 3

Spearman correlation analysis between variables and clinical outcomes"

Variables r P
Diameter of tumor vs. warm ischemia time -0.179 0.383
Diameter of tumor vs. overall operative time 0.051 0.804
Diameter of tumor vs. estimated blood loss -0.073 0.722
Diameter of tumor vs. length of stay -0.141 0.491
Overall operative time vs. estimated blood loss 0.646 0.001
Warm ischemia time vs. estimated blood loss 0.138 0.502
Overall operative time vs. length of stay 0.192 0.347
[1] Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy[J]. J Urol, 2010,183(2):473-479.
pmid: 20006866
[2] Teishima J, Takayama Y, Iwagum S, et al. Usefulness of persona-lized three-dimensional printed model on the satisfaction of pre-operative education for patients undergoing robot-assisted partial nephrectomy and their families[J]. Int Urol Nephrol, 2018,50(6):1061-1066.
[3] Hekman MCH, Rijpkema M, Langenhuijsen JF, et al. Intraoperative imaging techniques to support complete tumor resection in partial nephrectomy[J]. Eur Urol Focus, 2018,4(6):960-968.
pmid: 28753888
[4] 朱刚, 邢金春, 翁国斌, 等. 全息影像术中导航在泌尿外科腹腔镜和机器人手术中的应用价值[J]. 中华泌尿外科杂志, 2020,41(2):131-135.
[5] Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth[J]. J Urol, 2009,182(3):844-853.
[6] 张树栋. 复杂情况腹腔镜肾部分切除术的方法探讨(附光盘)[J]. 现代泌尿外科杂志, 2016,21(5):325-328.
[7] 张树栋, 马潞林, 黄毅, 等. 改良Pfannenstiel 切口取肾的经腹途径腹腔镜肾癌根治术[J]. 北京大学学报(医学版), 2014,46(4):638-641.
[8] Garisto J, Bertolo R, Dagenais J, et al. Robotic versus open partial nephrectomy for highly complex renal masses: comparison of perioperative, functional, and oncological outcomes[J]. Urol Oncol, 2018, 471.e1-471.e9.
[9] 张树栋. 肾门区肿瘤腹腔镜保留肾单位手术的决策(附光盘)[J]. 现代泌尿外科杂志, 2018,23(5):323-327.
[10] Reinhart MB, Huntington CR, Blair LJ, et al. Indocyanine green: Historical context, current complications,and future considerations[J]. Surg Innov, 2016,23(2):166-175.
pmid: 26359355
[11] Simone G, Gabriele Tuderti G, Anceschi U, et al. Ride the green light: Indocyanine green-marked off-clamp robotic partial nephrectomy for totally endophytic renal masses[J]. Eur Urol, 2019,75(6):1008-1014.
pmid: 30262342
[12] Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: The 2019 update[J]. Eur Urol, 2019,75(5):799-810.
[13] Fernando A, Fowler S, O’Brien T. Nephron-sparing surgery across a nation-outcomes from the British Association of Urological Surgeons 2012 National Partial Nephrectomy Audit[J]. BJU Int, 2016,117(6):874-882.
[1] ZHANG Fan,HUANG Xiao-juan,YANG Bin,YAN Ye,LIU Cheng,ZHANG Shu-dong,HUANG Yi,MA Lu-lin. Relationship between prostate apex depth and early recovery of urinary continence after laparoscopic radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 692-696.
[2] QIU Min,WANG Lu,DENG Shao-hui,TA Peng-fei,GUO Wei,LU Jian,LIU Cheng,MA Lu-lin. Primary application of Gerota’s fascia suspension device in retroperitoneal laparoscopic partial nephrectomy [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 789-792.
[3] CHI Yan-ting,ZHANG Yan-ping,ZHANG Qiu-lu,LIU Cui-ling,LI bin-bin. Clinicopathological analysis of mucosa associated lymphoid tissue lymphoma secondary to Sjögren’s syndrome in salivary gland [J]. Journal of Peking University (Health Sciences), 2021, 53(1): 40-45.
[4] Bing-wei HUANG,Jie WANG,Peng ZHANG,Zhe LI,Si-cheng BI,Qiang WANG,Cai-bo YUE,Kun-lin YANG,Xue-song LI,Li-qun ZHOU. Application of indocyanine green in complex upper urinary tract repair surgery [J]. Journal of Peking University (Health Sciences), 2020, 52(4): 651-656.
[5] Si-da CHENG,Xin-fei LI,Sheng-wei XIONG,Shu-bo FAN,Jie WANG,Wei-jie ZHU,Zi-ao LI,Guang-pu DING,Ting YU,Wan-qiang LI,Yong-ming SUN,Kun-lin YANG,Lei ZHANG,Han HAO,Xue-song LI,Li-qun ZHOU. Robot-assisted laparoscopic upper urinary tract reconstruction surgery: A review of 108 cases by a single surgeon [J]. Journal of Peking University (Health Sciences), 2020, 52(4): 771-779.
[6] Hai-yue ZHAO,Xiong-jun YE,Wei-nan CHEN,Li-zhe AN,Jun LIU,Liu-lin XIONG,Xiao-bo HUANG. Treatment of crossing vessels in laparoscopic pyeloplasty [J]. Journal of Peking University(Health Sciences), 2019, 51(4): 660-664.
[7] Si-da CHENG,Wan-qiang LI,Li MU,Guang-pu DING,Bo ZHANG,Cheng SHEN,Ze-wei YING,Kun-lin YANG,Han HAO,Xue-song LI,Li-qun ZHOU. Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment [J]. Journal of Peking University(Health Sciences), 2019, 51(4): 758-763.
[8] Hai-wen HUANG,Bing YAN,Mei-xia SHANG,Li-bo LIU,Han HAO,Zhi-jun XI. Propensity-matched comparison of laparoscopic and open radical cystectomy for female patients with bladder cancer [J]. Journal of Peking University(Health Sciences), 2019, 51(4): 698-705.
[9] Jia-yu WANG,Mei-ping ZHAO. Fluorescence assay for the detection of apurinic/apyrimidinic endonuclease 1 (APE1) activity in human blood samples [J]. Journal of Peking University(Health Sciences), 2019, 51(3): 487-492.
[10] Ling-fu ZHANG,Chun-sheng HOU,Yong-hui HUANG,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU. Comparison of the minimally invasive treatments of laparoscopic and endosopic for common bile duct stones after gastrojejunostomy [J]. Journal of Peking University(Health Sciences), 2019, 51(2): 345-348.
[11] Xiao-jun TIAN,Min QIU,Zhuo LIU,Ruo-tao XIAO,Yi HUANG,Guo-liang WANG,Xiao-fei HOU,Shu-dong ZHANG,Shen-rong ZHUANG,Lu-lin MA. Single-center study of laparoscopic radical nephrectomy with Mayo 0-2 level inferior vena cava thrombectomy [J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1053-1056.
[12] XU Ben, ZHANG Zhe-nan, LUO Cheng, SONG Hai-feng, ZHANG Qian. Comparison of safety and effectiveness between retroperitoneal laparoscopic tumor aspiration and laparoscopic partial nephrectomy in the treatment of renal angiomyolipoma [J]. Journal of Peking University(Health Sciences), 2018, 50(4): 700-704.
[13] FENG Yong-liang, FAN Jing-hui, LIN Xian-juan, YANG Ji-chun, CUI Qing-hua, TANG Xin-jing, XU Guo-heng, GENG Bin. Facilitating the measurement of circulatory hydrogen sulfide with fluorescence probe-coated microplates [J]. Journal of Peking University(Health Sciences), 2017, 49(6): 1060-1065.
[14] WANG Fang, ZHANG Yan-qin, DING Jie, YU Li-xia. Detection of large deletions in X linked Alport syndrome using competitive multiplex fluorescence polymerase chain reaction [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 760-767.
[15] LIU Jia-yuan, PENG Xiang, NING Xiang-hui, LI Teng, PENG Shuang-he, WANG Jiang-yi, LIU Sheng-jie, DING Yi, CAI Lin, GONG Kan. Clinical value of fluorescence in situ hybridization positive of exfoliated urothelial cells in urothelial carcinoma [J]. Journal of Peking University(Health Sciences), 2017, 49(4): 585-589.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] Author. English Title Test[J]. Journal of Peking University(Health Sciences), 2010, 42(1): 1 -10 .
[2] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 188 -191 .
[3] . [J]. Journal of Peking University(Health Sciences), 2009, 41(3): 376 -379 .
[4] . [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 459 -462 .
[5] . [J]. Journal of Peking University(Health Sciences), 2010, 42(1): 82 -84 .
[6] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 319 -322 .
[7] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 333 -336 .
[8] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 337 -340 .
[9] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 225 -328 .
[10] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 346 -350 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd