Effect of indocyanine green fluorescence imaging technology in robot-assisted laparoscopic hemi-nephrectomy for duplex kidney in children
10.3760/cma.j.cn112330-20241226-00570
- VernacularTitle:吲哚菁绿荧光显影技术在儿童重复肾机器人辅助腹腔镜半肾切除术中的应用效果
- Author:
Xiong ZHAN
1
;
Jinpu PENG
1
;
Moudong WU
1
;
Dan WANG
1
;
Mujie LI
1
;
Nini AN
1
Author Information
1. 贵州省人民医院儿童泌尿外科，贵阳 550001
- Publication Type:Journal Article
- Keywords:
Indocyanine green;
Robotic-assisted laparoscopy;
Duplex Kidney;
Hemi-nephrectomy;
Child
- From:
Chinese Journal of Urology
2025;46(8):607-610
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Exploring the efficacy of indocyanine green（ICG）near-infrared fluorescence（NIRF）imaging technology in robotic-assisted laparoscopic partial nephrectomy for children with duplicated kidneys.Methods:A retrospective analysis was conducted on the medical records of 7 children with duplicated kidneys admitted to Guizhou Provincial People's Hospital from December 2023 to September 2024，including 3 males and 4 females. The patients with a median age of 36（2，132）months. All cases of duplicated kidneys were located at the renal pole，with 5 on the left side and 2 on the right side. All 7 patients had a history of worsening hydronephrosis，with 4 having a history of urinary tract infection and 1 accompanied by urinary incontinence（urine leakage outside the normal voiding period）. Preoperative diagnosis was confirmed via enhanced CT of the urinary tract，diuretic renal dynamic imaging（SPECT），and voiding cystourethrography. One case had an ectopic ureteral opening. One case had recurrent urinary tract infections following ureteral cyst fenestration surgery，and five cases had terminal ureteral obstruction. All seven cases showed that the functional capacity of the duplicated upper kidney was <10%. All 7 cases underwent robot-assisted laparoscopic repeated nephrectomy of the upper kidney using ICG-NIRF technology. Intraoperative ICG fluorescence imaging was performed in three stages：a catheter was inserted through the lower kidney ureter，and after the first injection of ICG，green fluorescence was observed in the lower kidney ureter. Under fluorescence guidance，the upper and lower ureters were anatomically dissected；The second ICG injection via intravenous administration revealed the vessels supplying the upper kidney，and the blood supply to the upper kidney was blocked；After the third ICG injection via intravenous administration，the normal lower kidney showed fluorescence imaging，while the ischemic upper kidney did not. The upper kidney was resected along the anatomical boundary between the upper and lower kidneys.Results:All 7 surgeries were successfully completed，with an average surgical time of（155.1 ± 22.7）min；Intraoperative blood loss was（12.5 ± 8.7）ml；postoperative hospital stay was（5.2 ± 1.7）days. Postoperative follow-up duration was（9.2 ± 3.5）months，with preoperative concomitant urinary tract infection and post-micturition dribbling symptoms resolved. No cases of ureteral stump effusion or urinary leakage were observed postoperatively. At the 3-month postoperative follow-up SPECT examination，no loss of lower kidney function was detected.Conclusions:The application of ICG-NIRF imaging technology in robotic-assisted laparoscopic heminephrectomy for children with duplicated kidneys is easy to perform and safe. Its main advantage is the ability to clearly identify normal ureters，blood vessels of non-functional kidneys，and the boundary between the upper and lower halves of the kidney，thereby guiding the optimization of surgical strategies.
