• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

A NOVEL APPLICATION OF INDOCYANINE GREEN DURING ROBOTIC ASSISTED HEMINEPHRECTOMY TO ASSESS THE EFFECTIVENESS OF VASCULAR CLAMPING

S Gruessner, MD, MBA, F Gheza, MD, A Mangano, MD, LF Gonzalez Ciccarelli, MD, PC Giulianotti, MD. University of Illinois at Chicago

Background/Hypothesis: Indocyanine Green (ICG) has an unquestionable versatility in the field of minimally invasive surgery. We postulate that ICG is an effective alternative to Doppler Ultrasound in assessment of effectiveness of vascular clamping during a heminephrectomy. In this case, we have a 42 year old morbidly obese (BMI 35) male with incidental finding of solid mass in the upper pole of the right kidney by CT.

Materials & methods: the patient underwent a laparoscopic, robotic assisted right heminephrectomy with intraoperative ultrasound for lesion localization and vascular assessment. Due to the high BMI, a complete dissection of the hilum was difficult and risky; we decided to perform a total hilum clamping, instead of our typical arterial dissection and selective clamping. After gaining access to the Kidney, a right renal superior polar branch was discovered and ligated, and the renal pedicle was clamped. We used an injection of 7.5mg ICG peripherally (5mg/mL) to assess total occlusion of the vascular inflow of the kidney, which was impossible to assess in this condition with the doppler probe. Waiting for a clear parenchymal phase, we could confirm the complete absence of flow to the kidney. When the parenchyma was resected using curved harmonic shears, we experienced small back bleeding only, and we could preemptively close the open calyces and secure minor medullary bleeding.

Results: Using ICG, we were visually able to assess successful occlusion of blood supply to the kidney during a difficult heminephrectomy, that in this case was not reliable with the interaoperative Doppler. The patient’s hospital course was uncomplicated, and he was discharged 4 days after the surgery.

Conclusions: ICG is an alternative to Doppler Ultrasound in the assessment of total vascular clamping, when a complete arterial dissection could be difficult. With ICG, there is no need to individually probe each renal segment, particularly when incomplete hilum exposure doesn't allow to detect each single branch. We believe that ICG can be a highly versatile tool in minimally invasive surgery, and its use in this video is just one example of many potential novel applications.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95654

Program Number: V100

Presentation Session: Exhibit Hall Theater Video Session IV

Presentation Type: EHVideo

96

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons