V05-06 the Utility of Cystoscopic Injection of Indocyanine Green in Robotic-Assisted Partial Cystectomy

You have accessJournal of UrologyPediatrics (V05)1 May 2024V05-06 THE UTILITY OF CYSTOSCOPIC INJECTION OF INDOCYANINE GREEN IN ROBOTIC-ASSISTED PARTIAL CYSTECTOMY Britney Lau, Candace Granberg, and Patricio Gargollo Britney LauBritney Lau , Candace GranbergCandace Granberg , and Patricio GargolloPatricio Gargollo View All Author Informationhttps://doi.org/10.1097/01.JU.0001009516.84627.21.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indocyanine green (ICG) can be injected intravenously or directly into organs to assess vascularization or identify tissue. Firefly near-infrared fluorescence (NIRF) is a feature of the da Vinci robot system which allows visualization of ICG. The use of ICG and NIRF in robotic-assisted urologic surgery has been described in the literature for many surgeries including partial nephrectomy, prostatectomy, pelvic and inguinal lymphadenectomy, and upper tract reconstruction. There has been one case study that describes the use of ICG fluorescence guided partial cystectomy for urachal carcinoma. We demonstrate the use of ICG fluorescence guided robotic-assisted partial cystectomy for inflammatory myofibroblastic tumor (IMT) in a pediatric patient with a bladder mass that was refractory to systemic steroid therapy. We aim to show the technique for cystoscopic injection and how the visualization of ICG under NIRF can guide partial cystectomy. METHODS: Rigid cystoscopy was performed using a 9.5 French pediatric cystoscope. This demonstrated a 2 cm nodular tumor at the dome of the bladder. Using a 3.7 French x 23 gauge x 350 mm needle, a total of 3 mL of intradetrusor ICG was injected circumferentially around the tumor. 10 French Foley catheter was placed. The robot was docked, and Firefly NIRF was used to identify the areas injected with ICG. The margins were marked out using cautery, then robotic-assisted partial cystectomy was performed. Bladder was closed in 2 layers using 3-0 barbed suture in a running fashion. Leak test was negative with instillation of 200 mL normal saline. RESULTS: Pathology demonstrated a 1.1 cm tumor with atypical spindle cell and eosinophilic proliferation consistent with IMT variant, and negative surgical margins. Patient was discharged on postoperative day 1 with Foley catheter, which was removed in 10 days. Patient will be seen in follow up with a renal bladder ultrasound. CONCLUSIONS: Intradetrusor injection of ICG is an effective tool for identification of tumor margins in robotic-assisted partial cystectomy for inflammatory myofibroblastic tumor. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e269 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Britney Lau More articles by this author Candace Granberg More articles by this author Patricio Gargollo More articles by this author Expand All Advertisement PDF downloadLoading ...