Near-infrared fluorescence imaging

Emerging applications in robotic upper urinary tract surgery

Marc A. Bjurlin, Melanie Gan, Tyler R. McClintock, Alessandro Volpe, Michael S Borofsky, Alexandre Mottrie, Michael D. Stifelman

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. Objective To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participants Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedure We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysis Patient characteristics, perioperative outcomes, and complications were analyzed. Results and limitations Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1-3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n = 20), ureteral reimplant (n = 13), ureterolysis (n = 7), and ureteroureterostomy (n = 2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. Conclusions Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.

Original languageEnglish (US)
Pages (from-to)793-801
Number of pages9
JournalEuropean Urology
Volume65
Issue number4
DOIs
StatePublished - Apr 1 2014

Fingerprint

Optical Imaging
Robotics
Urinary Tract
Nephrectomy
Constriction
Technology
Warm Ischemia
Glomerular Filtration Rate
Sample Size
Angiography
Ischemia

Keywords

  • Indocyanine green
  • Near-infrared fluorescence imaging
  • Robotic partial nephrectomy
  • Surgical technique
  • Upper urinary tract reconstruction
  • reconstruction

Cite this

Near-infrared fluorescence imaging : Emerging applications in robotic upper urinary tract surgery. / Bjurlin, Marc A.; Gan, Melanie; McClintock, Tyler R.; Volpe, Alessandro; Borofsky, Michael S; Mottrie, Alexandre; Stifelman, Michael D.

In: European Urology, Vol. 65, No. 4, 01.04.2014, p. 793-801.

Research output: Contribution to journalArticle

Bjurlin, MA, Gan, M, McClintock, TR, Volpe, A, Borofsky, MS, Mottrie, A & Stifelman, MD 2014, 'Near-infrared fluorescence imaging: Emerging applications in robotic upper urinary tract surgery', European Urology, vol. 65, no. 4, pp. 793-801. https://doi.org/10.1016/j.eururo.2013.09.023
Bjurlin, Marc A. ; Gan, Melanie ; McClintock, Tyler R. ; Volpe, Alessandro ; Borofsky, Michael S ; Mottrie, Alexandre ; Stifelman, Michael D. / Near-infrared fluorescence imaging : Emerging applications in robotic upper urinary tract surgery. In: European Urology. 2014 ; Vol. 65, No. 4. pp. 793-801.
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abstract = "Background Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. Objective To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participants Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedure We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysis Patient characteristics, perioperative outcomes, and complications were analyzed. Results and limitations Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3{\%}. There was a 12.5{\%} complication rate, and all complications were Clavien grade 1-3 (14.3{\%}). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n = 20), ureteral reimplant (n = 13), ureterolysis (n = 7), and ureteroureterostomy (n = 2). Radiographic and symptomatic improvement was observed in 100{\%} of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4{\%} of ureterolysis patients, for an overall success rate of 95.2{\%}. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. Conclusions Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.",
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AU - Volpe, Alessandro

AU - Borofsky, Michael S

AU - Mottrie, Alexandre

AU - Stifelman, Michael D.

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N2 - Background Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. Objective To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participants Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedure We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysis Patient characteristics, perioperative outcomes, and complications were analyzed. Results and limitations Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1-3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n = 20), ureteral reimplant (n = 13), ureterolysis (n = 7), and ureteroureterostomy (n = 2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. Conclusions Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.

AB - Background Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. Objective To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participants Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedure We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysis Patient characteristics, perioperative outcomes, and complications were analyzed. Results and limitations Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1-3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n = 20), ureteral reimplant (n = 13), ureterolysis (n = 7), and ureteroureterostomy (n = 2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. Conclusions Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.

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