Fluorescent Imaging Assists Robotic Partial Nephrectomy Surgery

A new surgical technique integrates infrared (IR) fluorescent imaging and a robotic surgical system for minimally invasive removal of kidney cancer.

Developed by researchers at the University of Rochester Medical Center (URMC; NY, USA) in collaboration with Intuitive Surgical (Sunnyvale, CA, USA), the new technique integrates the fluorescent imaging system and the surgical console into one system. This multimodal imaging allows surgeons to turn their attention back and forth from different types of images to the surgical tools, without stepping away from the console. The new system will serve as an adjunct to existing imaging, allowing surgeons to achieve better resection margins around the cancer and with fewer bleeding complications.

The researchers have successfully performed robotic laparoscopic partial nephrectomies on patients at Strong Memorial Hospital (Rochester, NY, USA) using the new technology. In the 11 patients treated, the kidney tumors and surrounding renal arteries were clearly identified, and malignant tissue was differentiated from normal tissue. Additionally, due to the laparoscopic approach, the incisions needed for use of the da Vinci system are much smaller than the incisions from traditional, open surgery, allowing for faster recoveries and fewer complications; existing da Vinci systems can be upgraded with the new imaging technology.

"This combination of new and existing technology offers great potential and opens the door to being able to provide the option of minimally invasive surgery to a greater percentage of patients, and to preserve kidney function in a greater percentage of patients,” said lead researcher Dragan Golijanin, MD. "Through further study we'll fine tune the process to determine the optimal dosing of the infrared dye, the exact timing of the intravenous injection, and determine whether this new imaging technology actually improves outcomes, both in terms of cancer prognosis and the preservation of kidney function. By simplifying the imaging process, it will also assist young urologists and decrease the number of cases needed to master robotic laparoscopic partial nephrectomy.”

Renal cell carcinoma is diagnosed in more than 58,000 people a year in the United States alone and was responsible for more than 13,000 kidney cancer specific deaths in 2010. Surgery is usually the first, and in many cases, only course of treatment. For small tumors (i.e., less than 5 cm) robot-assisted laparoscopic partial nephrectomy is an emerging technique that has gained acceptance; the procedure removes the cancer while preserving as much healthy, unaffected kidney tissue, and kidney function, as possible for the patient.

Related Links:
University of Rochester Medical Center
Intuitive Surgical
Strong Memorial Hospital