Category: Laparoscopic/ Robotic: Other

MP16-16 - Usefulness of intraoperative contrast-enhanced ultrasonography for robot-assisted partial nephrectomy (RAPN)

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Partial nephrectomy for small renal carcinoma may reduce the incidences of chronic kidney disease (CKD) and cardiovascular complications in comparison with nephrectomy. In various guidelines, it is recommended as standard treatment for patients with small renal carcinoma. In Japan, robot-assisted partial nephrectomy (RAPN) became covered by health insurance in 2016, and has been routinely performed.

For RAPN, it is important to form a mental image of an accurate resection line. To achieve this, intraoperative ultrasonography may be essential. On the other hand, the tumor margin is not clearly visualized on B-mode ultrasonography in some cases, raising an issue.

Methods :

The subjects were 5 patients for whom color Doppler ultrasonography with ultrasonic contrast medium was performed during RAPN. The mean age was 61.8 years (44-69 years). The right kidney was affected in 2 patients, and the left kidney in 3. The mean tumor diameter was 27.2 mm (15-40 mm). A drop-in-type ultrasonic probe for robots was inserted into the abdominal cavity, and displayed on a console screen using a TilePro™ multi-display. After administering ultrasonic contrast medium (Sonazoid), tumor blood flow was examined. In addition, we investigated whether selective ischemia of blood vessels supplying tumor facilitates the confirmation of tumor blood flow blockage in 3 patients.

Results :

In patients in whom the tumor margin was unclear on B-mode ultrasonography, encasement vessels surrounding the tumor were clearly visualized when adopting color Doppler ultrasonography. The use of ultrasonic contrast medium made the encasement clearer. Furthermore, it was possible to clearly confirm the extent of ischemia caused by the clamping of blood vessels that were considered to supply the tumors before surgery. 

Conclusions :

The results showed that B-mode/color Doppler ultrasonography and ultrasonic contrast medium were useful for identifying the tumor contour or tumor vessels/blood vessels to be preserved. Furthermore, this procedure facilitated the real-time confirmation of the vasculature of a tumor-supplying blood vessel simulated by three-dimensional CT before surgery. Contrast-enhanced Doppler ultrasonography may be useful for evaluating whether selective ischemia or resection of tumor- supplying blood vessels should be performed.

Fumiya Hongo

Associate Professor
Kyoto Prefectural University of Medicine
Kyoto, Kyoto, Japan

Atsuko Fujihara

Kyoto, Kyoto, Japan

Yuta Inoue

Kyoto, Kyoto, Japan

Nomura Takeshi

Kyoto, Kyoto, Japan

Tsukasa Narukawa

Kyoto, Kyoto, Japan

Yasuyuki Naitoh

Kyoto, Kyoto, Japan

Osamu Ukimura

Kyoto, Kyoto, Japan