Ajay H Bhandarwar, MS, Chintan B Patel, MS, Saurabh S Gandhi, MS, Amol N Wagh, MS, Priyank D Kothari, MS, Eham L Arora, MS, Hridaynath V Desai, MS. Grant Government Medical College & Sir J.J. Group of Hospitals
Objective: Indocyanine Green Angiography (ICG) pinpoint system helps to assess vascular flow, Tissue Perfusion, Aberrant Anatomy.
We hereby evaluate the utility of ICG Near Infrared imaging system for radical nephrectomy surgery as a potential tool to lower conversion rates.
Description: Pinpoint ICG system is a novel technique which provides real time endoscopic visible and near infrared fluorescence imaging with 4 modes. i.e. Pinpoint mode, Colour segmented Flourescence mode, (CSF Mode) , SPY mode, HD white light mode.
It combines image on same plane enabling coupling of images and simultaneous dissection without switching to normal White light mode while dissection.
Variations in Renal arteries accounts for 30 % of its existence. Changes in the origin of the renal arteries have been reported since Bartholin in the 17th century. However the classical description of the renal vasculature formed only by one artery and one vein occurs in less than 25 percent of cases.
These variations increase the risk of hemorrhage and segmental ischemia. The presence of multiple renal arteries as well as the pattern of their prehilar divisions , should be assessed because of their importance in relation to blood supply and influence the dissection and access plan to renal hilum in laparoscopic surgeries.
Most frequent cause to conversion to open is uncontrolled Intraoperative bleeding secondary to anatomical variations missed during laparoscopic dissection near renal hilum which amounts to 2 % nephrectomies performed worldwide.
Results: In our tertiary care center with case series of 15 cases of ICG pinpoint nephrectomies, conversion to open case was nil.
| Approach | Minor Bleeding | Major Bleeding | Mean Operative time | Conversion to Open |
Reactionary Hemmorhage (hematoma) |
| Laparoscopic(n=15) | 6 | 3 | 155 | 2 | 1 |
| ICG Pinpoint(n=10) | 2 | 0 | 124 | 0 | 1 |
Conclusion: ICG system is safe and feasible option to evaluate vascular flow, tissue perfusion and aberrant vascular variations.
Assessing the potential on basis of surgeon interest , this represents only the beginning of an expanding list of clinical application of this pioneering technology to lower conversion rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84342
Program Number: ETP742
Presentation Session: Emerging Technology Poster
Presentation Type: Poster