ICG NAVIGATION IN THE TREATMENT OF HYDRONEPHROSIS CAUSED BY ABERRANT LOWER POLAR RENAL VESSELS IN A 5-YEAR-OLD BOY: A CLINICAL CASE

Abstract

This research represents a new technique for assessing ureteral patency in a patient with renovascular hydronephrosis using the ICG navigation. Materials and methods used: a clinical case of successful treatment of obstruction of pyeloureteral junction of the left kidney caused by aberrant lower pole vessels using laparoscopic hitching performed under fluoroscopic control. The surgical intervention was performed with the use of Rubina® NIR/ICG telescopes with HOPKINS® rod lens system by KARL STORZ, Germany. The Rubina components offer various visualization modes for the ICG-NIRF signal. Depending on the preferences of the surgeon and the application of the ICG-NIRF, the data can be displayed in different modes: image overlay mode, monochrome mode, color mapping mode. After confirmation of ureteral patency using ICG imaging, a laparoscopic hitching was performed. Results: the use of ICG visualization was very helpful in identifying the ureter that stained intensely after indocyanine green injection into the lumen of the pelvis with a ureteral catheter. This test confirmed the absence of an internal type of obstruction of pyeloureteral junction and made it possible to opt for hitching. In the ICG-NIRF data overlay mode, the ureter was stained in intense green. When the monochrome mode was used, the upper third of the ureter was stained intensely white. Finally, the ICG-NIRF signal intensity mapping mode of the proximal ureter turned green-blue. The next day after the vascular hitching, a control ultrasound examination of the kidney was performed with the measurement of the anteroposterior diameter of the pelvis, which demonstrated a decrease in the size of the pelvis to 20 mm. A follow-up study performed six months after the surgical intervention showed further decrease in the anteroposterior diameter of the pelvis to 8 mm. Conclusion: thus, ICG navigation is a promising method for minimally invasive evaluation of pyeloureteral junction patency in patients with vasorenal hydronephrosis.