V10-04: Minimally-invasive partial nephrectomy employing 4K visualization system with OPAL 1 near-Infrared and indocyanine green technology

Pietro Diana*, Andrea Gallioli, Alberto Piana, Angelo Territo, Julia Aumatell, Alejandra Bravo, Josep Maria Gaya, Jordi Huguet, Antonio Rosales, Francesco Sanguedolce, Pavel Gavrilov, Joan Palou, Alberto Breda, Barcelona, Spain

Introduction: Renal function preservation is one of the objectives of partial nephrectomies. Minimally-invasive surgery has allowed to decrease post-operative morbidity maintaining curative results in cT1 masses. New technologies are continuously developing in order to precisely visualize the vascular supply of the tumor and spare healthy parenchyma. We propose a clinical case in which the new visualization system Image 1S Rubina with OPAL 1 NIR/ICG has been employed.

Methods: We present a case of a 65 year-old male with no previous medical history. In February 2021 after an episode of hematuria underwent an abdominal US that described a left renal mass that was confirmed at CT scan and laparoscopic partial nephrectomy was indicated. Before the surgery a 3D reconstruction was performed confirming a 34 mm hilar mass in relations with the superior renal calyxes. The Image 1S Rubina with OPAL 1 near infrared/indocyanine green (NIR/ICG) technology by Storz was employed for this procedure.

Results: This new visualization system combines the 4K high resolution with fluorescence imaging providing an overlay of NIR/ICG data onto the standard white light. This technology allows an ICG-assisted tumor enucleation as the ischemic tumor margins are in contrast with the very well vascularized parenchyma. Monochromatic visualization of the field can be performed displaying the ICG signal in white on a black background achieving the greatest contrast between elements. Additionally, an overlay intensity map visualization can be set highlighting in different color the parenchyma respecting the ICG density in the tissue reflecting the vitality of the parenchyma. The feeding arterial branch was detected and sectioned before the enucleation as it was entering the mass itself. The total operative time was 145 min and the estimated blood loss was 70cc. The post-operative stay was devoid of complications. The patient was discharged at post-operative day 3. Pathological analysis detected a clear cell renal carcinoma with negative margins.

Conclusions: This kind of technology allows a 4K resolution image and the NIR/ICG image with different overlay modes. This strengthen the insight of the tissue vascularization and vitality guiding the enucleation of the renal mass guaranteeing a parenchymal-sparing technique and thus preserving renal function.

Source of Funding: none