FLUORESCENCE-GUIDED SURGERY. THE FIRST USE IN CHILDREN

Abstract

Article represents the first use of fluorescence-guided surgery in pediatric patients and demonstrates procedures that can be recommended for use in children. Materials and methods used: medical records of 28 pediatric patients who underwent laparoscopic and thoracoscopic procedures under fluorescence guidance were studied. Surgical procedures were performed using Rubina® endovideosurgical system by KARL STORZ, Germany. The most frequently performed surgical procedure in childhood was laparoscopic varicocelectomy, with 10 cases where ICG navigation was used to identify testicular lymphatic vessels. This was followed by: cholecystectomy - 6, resection of mature ovarian teratoma - 5, fenestration of a kidney cyst - 3, resection of a non-functioning segment of a horseshoe kidney - 1, removal of ganglioneuroblastoma of intrathoracic localization - 1, laparoscopic relocation of an aberrant lower polar renal vessel with hydronephrosis – 1, and resection of colon enterocystoma - 1. Results: the average age of patients at the time of surgery was 13.2±3.3 y/o (median 14.0 [12.0; 15.0] y/o). The average weight of patients at the time of surgery was 64.1±18.8 kg (median 68.0 [58.0; 78.0] kg). Most often, the drug was administered during surgery - 10 cases, 10 hours before surgery (cholecystectomy) - 6 cases, and one day before surgery - removal of enterocystoma of the colon. Methods of administration were distributed as follows: intravenous administration of the drug was used in 16 cases, intratesticular (varicocele) - 10, intraluminal (for vasorenal hydronephrosis) - 1, and intramural using endoscopy - 1 (for enterocyst of the colon). In all cases, the surgical interventions proceeded without intraoperative complications and without conversions into open inteventions. The duration of surgical intervention averaged 63.9±44.0 minutes (median 40.0 [31.3, 98.8] minutes). The duration of stay in the intensive care unit averaged 10.2±19.9 minutes (median 2.5 [2.0, 15.5] minutes). The duration of hospitalization averaged 3.6±1.0 days (median 3.0 [3.0, 4.0] days). No information was provided on the side effects of ICG administration, nor was there any convincing evidence for the occurrence of early or late postoperative complications. Conclusion: results support the conclusion that laparoscopic procedures performed in children using ICG navigation are beneficial, as the primary goal of safely providing visual guidance of the target surgical anatomy was achieved.