Indocyanine Green Fluorescence-Guided Laparoscopic Lower-Pole Heminephrectomy for Duplex Kidney in Adult

Intraoperative indocyanine green (ICG) near-infrared fluorescence guidance is a type of optical imaging technology now available to facilitate a better understanding of surgical landmarks. This case describes use of this technique during lower-pole heminephrectomy for a patient with duplex kidney. A 50-year-old woman with a left duplex system and lower-pole kidney infection underwent a laparoscopic transperitoneal lower-pole heminephrectomy. After exposing the left renal pedicles, ICG was administered through a ureteral stent inserted into the upper calix; the nonaffected ureter could be viewed, which enabled us to dissect the affected ureter connected to the lower-pole pelvis. Next, intravenous ICG administration revealed that the lower-pole kidney blood flow was not reduced. This finding prompted us to clamp the main renal artery. Furthermore, ICG injection through a nephrostomy tube helped to observe the lower-pole kidney collecting system and predict the parenchymal dissection plane location between the upper- and lower-pole kidneys. We effectively performed a lower-pole heminephrectomy through complete lower-pole urinary tract resection and maximal upper-pole parenchyma preservation. ICG fluorescence by intravenous and intraureteral administration observes relevant anatomy intraoperatively and is beneficial in patients who undergo a lower-pole heminephrectomy for duplex kidney.