Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: A descriptive series

Area of Science:

• Pediatric surgery
• Urology
• Surgical innovation

Background:

• Heminephrectomy carries a 4-5% risk of innocent moiety injury, potentially causing long-term complications in children.
• Selective arterial mapping (SAM) using indocyanine green (ICG)-aided near infrared fluorescence (NIRF) imaging is established for adult partial nephrectomies but not yet documented for pediatric robot-assisted laparoscopic heminephrectomy (RALHN).

Purpose of the Study:

• To assess the feasibility of SAM with ICG-aided NIRF imaging during pediatric RALHN.
• To determine if real-time delineation of selective arterial anatomy aids surgical outcomes.
• To evaluate the safety and efficacy of this technique in a pediatric population.

Main Methods:

• A descriptive series of six pediatric patients undergoing RALHN utilizing SAM with ICG-aided NIRF imaging.
• The Firefly™ system on the da Vinci® surgical robotic console was employed for visualization.

Main Results:

• SAM was performed safely, without toxicity or vascular complications.
• The procedure did not increase operative time or surgical complexity.
• The primary additional cost was associated with the single-use ICG vial.

Conclusions:

• SAM with ICG-aided NIRF imaging is a feasible technique for pediatric RALHN.
• The method provides real-time anatomical information, alerting surgeons to unexpected findings and potentially preventing occult moiety injury.
• This technique enhances intraoperative safety and can mitigate short- and long-term adverse outcomes for children.