Robotic system lights the way to better kidney cancer surgeries

November 28, 2012 | by Shawn Le


kidney illustration Special lighting to make blood flow glow may help improve kidney cancer surgeries.

More kidney cancer surgeries may soon adhere to a basic directive in times of peril: In case of emergency, follow the glowing lights to the nearest exits.

The concept is simple but so profound that we see it used everywhere -- airplanes, movie theaters and, perhaps soon, cancer surgeries.

Some cancer specialists are using fluorescent dye that glows when exposed to near-infrared light. The dye shows them a route through the surgery, in a way. But their goal is to control the flow of blood, not people.

For surgeons, one major difficulty in treating kidney cancer is cutting out the tumor while preserving as much of the surrounding healthy tissue as possible.

A common approach to kidney cancer surgery is to temporarily stop blood flow to the entire organ by clamping off the main artery. While this minimizes blood loss during the surgery, it also has the side effect of strangling the entire kidney, including the heathy sections, and cutting off the flow of oxygen and nutrients that keep it alive.

Many surgeons try to selectively clamp the kidney to cut off blood flow in specific sections, but it can be difficult to confirm that only the intended areas are affected.

Clayton Lau M.D., and the other surgeons in City of Hope's Division of Urology and Urologic Oncology, are testing a new technology made possible by surgical robots. Surgeons infuse patients with the fluorescent dye, then use a special near-infrared attachment on the surgical robot known as the daVinci system to light up the blood flow.The fluorescent dye system enables surgeons to see the glowing blood flow through kidneys and to confirm that blood flow is shut down only in selected areas, or to make any necessary adjustments. The diseased sections of the kidney are deprived of blood so tumors can be removed, while healthy areas still get the nourishment they require.

City of Hope surgeons were the first in California to test the fluorescent dye system. They recently shared data on four kidney cancer patients who underwent treatment using the dye and selective clamping at the annual meeting of the American Urological Association’s Western Section.

The fluorescent dye system offers the potential for fewer complications from kidney surgery and improved recovery times. Further, the selective clamping leads to less damage to healthy tissue and to increased confidence in surgical excisions.

As the researchers said in their conclusion: “While further study is necessary, selective arterial clamping using the near-infrared fluorescent imaging system for the daVinci Robotic Surgical System  is feasible and may be a step towards further improvement in renal preservation during renal oncology surgery."

Lau and the other surgeons see this data as promising and will conduct additional testing to verify which benefits patients might see with the glow.

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