Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery

Alenezi, Ahmad; Karim, O.

doi:10.1007/s11701-015-0496-1

Cited by 26 publications

(17 citation statements)

References 26 publications

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“…The kidney and the pelvicalyceal system have no role in the accumulation and excretion of the contrast agents. Furthermore, in conditions of reduced renal blood perfusion, ischaemia, and diabetic nephropathy; the short duration of uptake of this contrast agent can safely be overcome by administering the agent as multiple injections . In our study, we have safely re‐injected the SonoVue contrast agent at least twice or three times in all patients without any adverse reported outcomes.…”

Section: Discussionmentioning

confidence: 84%

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Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow

Alenezi

Motiwala

Eves

et al. 2016

Int J Med Robotics Comput Assist Surg

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ObjectiveThe paper describes novel real‐time ‘in situ mapping’ and ‘sequential occlusion angiography’ to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS).Materials and methodsData were collected and assessed for 60 patients (61 tumours) between 2009 and 2013. 31 (50.8%) tumours underwent ‘Global Ischaemia’, 27 (44.3%) underwent ‘Selective Ischaemia’ and 3 (4.9%) were removed ‘Off Clamp Zero Ischaemia’. Demographics, operative variables, complications, renal pathology and outcomes were assessed.ResultsMedian PADUA score was 9 (range 7–10). The mean warm ischaemia time in selective ischaemia was less and statistically significant than in global ischaemia (17.1 and 21.4, respectively). Mean operative time was 163 min. Postoperative complications (n = 10) included three (5%) Clavien grade 3 or above. Malignancy was demonstrated in 47 (77%) with negative margin in 43 (91.5%) and positive margin in four (8.5%). Long‐term decrease in eGFR post selective ischaemia robotic partial nephrectomy was less compared with global ischaemia (four and eight, respectively) but not statistically significant.ConclusionsThis technique is safe, feasible and cost‐effective with comparable perioperative outcomes. The technical aspects elucidate the role of intraoperative CEUS to facilitate and ascertain selective ischaemia. Further work is required to demonstrate long‐term oncological outcomes. © 2016 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 84%

“…FireFly fluorescence with ICG necessitates a specialized camera and equipment, which makes it very costly. Recently published literature demonstrated intraoperative CEUS to be more cost‐effective and economically feasible compared with ICG . Sodium iodide is a constituent of ICG that potentially carries a risk of anaphylactic shock.…”

Section: Discussionmentioning

confidence: 99%

Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow

Alenezi

Motiwala

Eves

et al. 2016

Int J Med Robotics Comput Assist Surg

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“…This methodology assists zeroischemia partial nephrectomy techniques providing several more advantages than the fire-Fly technology, including non defatted kidney, good control of medullary blood flow, no toxicity (potential risk of allergic reactions to sodium iodide). RAPN was performed with selective clamping and evidence of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS (13)(14). Evidence has been reported on the higher safety of selective ischemia than total ischemia (15).…”

Section: Discussionmentioning

confidence: 99%

The role of intraoperative ultrasound in small renal mass robotic enucleation

Gunelli

Fiori

Salaris

et al. 2016

Arch Ital Urol Androl

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Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826). Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.KEY WORDS: Robotic ultrasound probe; Renal tumor; Simple enucleation; Psychomotor skills. SummaryNo conflict of interest declared.

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“…Another future application is related to robotic-assisted partial nephrectomy, which has gained prominence recently, as this approach has a shorter learning curve and a shorter warm ischemia time as compared to laparoscopic partial nephrectomy [32]. CEUS is capable of dynamic evaluation and quantification of microvasculature blood (capillary perfusion) in real time, without affecting renal function.…”

Section: Ceusmentioning

confidence: 99%

Harmonic Contrast-Enhanced Ultrasound (CEUS) of Kidney Tumors

Ciobanu¹,

Szora²,

Badea³

et al. 2020

Evolving Trends in Kidney Cancer

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Nowadays, kidney tumor diagnosis benefits from large and highly accurate imagistic methods. A new imagistic method is contrast-enhanced ultrasound (CEUS) that accurately depicts the circulatory pattern of tumors. In kidney pathology, any mass or even capsular deformation depicted by B mode ultrasound represents an indication for CEUS. The kidney is completely and uniformly vascularized. In cystic tumors, there is a lack of contrast loading. In "impure" cystic masses (Bosnian 3 and 4), CEUS reveals vascularized septa and walls. In malignant tumors, accelerated and heterogeneous loading of contrast agent is observed in arterial phase followed by early, inhomogeneous washout of the contrast agent compared to normal renal parenchyma. In the abscesses, the appearance is the early loading of the walls associated with moderate hyperemia of the normal circulatory bed. This chapter details the CEUS in kidney tumor pathology, emphasizing the accurate information for the circulatory pattern of renal masses. It requires correlations with clinical data and information provided by other imaging explorations to make a final diagnosis.

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Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery

Cited by 26 publications

References 26 publications

Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow

Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow

The role of intraoperative ultrasound in small renal mass robotic enucleation

Harmonic Contrast-Enhanced Ultrasound (CEUS) of Kidney Tumors

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