Category: Robotic Surgery: New Techniques - Malignant
Introduction & Objective :
Fluorescence-enhanced molecular imaging augmented with robot-assisted laparoscopic surgery can facilitate the performance of uro-oncologic cases. Indocyanine green (ICG) is a non-toxic, non-radioactive compound that enables deeper tissue penetration and improved visualization under near-infrared light. ICG can be given intravenously or via direct injection into the pathologic organ and its applications are diverse. In this video, we demonstrate utilization of fluorescence-enhanced molecular imaging in Robotic-assisted Uro-oncologic Surgery
Methods : ICG-NIRF has been used at our institution since 2010. Since then, we have used ICG in over 500 uro-oncologic cases, resulting in a constant refinement and precision of our surgical technique. In this video we demonstrate the many oncologic applications for ICG in the treatment of renal, adrenal, ureteral, prostate, and bladder pathologies.
ICG-NIRF applications for oncologic renal surgery includes assessing for adequate ischemia, viability of renorrhaphy, fluorescence patterns of renal lesions, and super-selective clamping when performing partial nephrectomy. ICG-NIRF can further facilitate cytoreductive nephrectomy by identifying vascular structures and assessing lymph node drainage patterns. In Nephroureterectomy, ICG can be instilled intravesically to ensure adequacy of bladder cuff and bladder repair, as well as assistance in lymph node dissection. For adrenal lesions, utilization of ICG-NIRF can provide histologic delineation of adrenal pathology and identification of vasculature and lymph node drainage patterns. In urothelial carcinoma of the ureter, ICG-NIRF can facilitate segmental resection and viability of the neo-cystotomy. For lower tract pathology such as bladder and prostate, direct injection of the pathologic organ can facilitate in structure identification and lymph node dissection. Furthermore, ICG-NIRF is quite useful in performing intracorporeal diversion as surgeons may assess anastomotic viability in real-time.
ICG offers unique advantages for the robotic uro-oncologic surgeon. Mastery of these techniques can facilitate the performance of uro-oncologic cases.
Wake Forest Baptist Medical Center
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina
Dr. Hemal is working as a professor in the department of Urology, Comprehensive Cancer Center & Prof., Institute for Regenerative Medicine at Wake Forest Baptist Medical Center. He is well known for his pioneering work in minimally invasive surgery. He has been active in the field of endourology since 1989, laparoscopy since 1992 and robot-assisted surgery since 2001. His contributions to laparoscopic & robot-assisted urologic surgery include the development of new techniques in uro-oncology & commitment to sharing and disseminating knowledge. He has conducted live demonstrations of endourological, laparoscopic & robot-assisted urologic procedures at more than 350 conferences around the world. He has been a visiting professor to more than 350 institutions around the globe to deliver guest lectures and keynote speeches. His trainees have been involved in the establishment of more than 50 minimally invasive programs. He has edited six books & 450 scientific papers and chapters in the book. He is on editorial board of several journals and President of society of robotic urologic surgery.He serves as a member of scientific committee in American Urology Association, World Congress of Endourology & SIU. Dr. Hemal has been the recipient of many academic distinctions and awards. He has been awarded three times by President of India including the most prestigious honor a physician can receive, the “Dr. B.C. Roy Award,” in 2004 for his contributions in the field of cost-effective minimally invasive surgery and highest civilian honor “Padma-Shree” in 2007 for development of robotic urologic surgery. Other prestigious awards to his credit are Urologist of the Decade award, Guest Scholar of the American College of Surgeons, SIU scholar and Fulbright scholar. Dr. Hemal is consistently included in Best Doctors of America, Top Doctors of America, Top Prostate Cancer Specialists and Who’s Who in the World for past several years.