Fluorescence imaging helps surgeons remove just the tumor, rather than the whole kidney
A surgical technology called Firefly is shedding new light on kidney cancers and helping doctors at MedStar Georgetown University Hospital remove tumors more safely and more efficiently while sparing the rest of the healthy kidney.
"The addition of Firefly fluorescence during robotic surgery improves our ability to remove kidney tumors when before we might have had to remove the whole kidney," said Keith Kowalczyk, MD, urologist and robotic surgeon. "Firefly, which essentially utilizes a dye that lights up in "firefly green" when using a specialized fluoroscopic camera, can show us the difference between cancerous and healthy tissue and helps us see the blood supply to the tumor. It lights up parts of the kidney and its blood supply we couldn't see this well before."
This new innovation uses the minimally-invasive precision of the da Vinci Surgical System, and adds the second component of Firefly fluorescence imaging. MedStar Georgetown is one of the first hospitals in the DC region to use this new technology.
When Eugene Carter of Washington, D.C. was diagnosed with kidney cancer, the decision to have robotic surgery by Dr. Kowalczyk while utilizing fluorescence imaging seemed the obvious choice.
"I'm 70, and with advanced age the hazards of surgery can increase, so I wanted the least invasive surgery possible," explained Mr. Carter. "The robotics provide more steadiness and precision, and I wanted my surgeon to be as steady and as precise as possible. It seems to me this is just a much wiser system."
How does it work? The Firefly technology uses near-infrared imaging to detect an injected tracer dye of indocyanine green (ICG) in the blood.
During surgery, urologists use the Firefly system at three different stages of the procedure. The first injection of the dye into the IV by the anesthesiologist gives a detailed picture of the blood supply to the kidney.
"Up to 25-percent of patients might have extra renal arteries that are not always obvious on a CT scan or MRI, so the Firefly can help us see these arteries. This helps us ensure that all of the blood supply to the kidney is accounted for and controlled prior to the removal of the tumor, and can therefore decrease blood loss," explained Dr. Kowalczyk.