Use of indocyanine green in resection of renal cysts in children

Abstract

Introduction. The study presents the experience of using ICG imaging to assess the margin of resection of a kidney cyst after intravenous administration of indocyanine green. Case reports. In the present study, we present a case report of laparoscopic treatment of simple renal cysts in two male patients aged 10 and 12 years. For this purpose, resection of the extrarenal portion of the kidney cyst was performed using fluoroscopic control by intravenous administration of indocyanine green. The intrarenal residue was subjected to argon-plasma coagulation. Treatment outcomes were assessed over a follow-up period of 6 and 12 months. The size of the cysts measured before surgery using ultrasound and computed tomography was 50 and 70 mm. Both cysts were located in the lower pole of the right kidney. The duration of the operation was 40 and 45 minutes, respectively. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighboring organs. The content of the cyst was in all cases a clear liquid without pathological impurities. Cytological examination revealed a low content of cells, which were represented by single macrophages and urothelial cells. Histological analysis revealed that the lining of the cyst wall was represented by transitional epithelium without signs of malignancy. The length of stay of patients in the hospital was 3 days. According to the ultrasound examination performed 1, 3, 6 and 12 months after the operation, there were no signs of recurrence of the disease. Conclusion. Thus, based on the presented clinical case, it can be assumed that the main advantage of using fluorescent technology during resection of kidney cysts include a clear definition of the demarcation line between the avascular wall of the cyst and the perfused kidney tissue, which helps prevent bleeding from the renal parenchyma.