Doctors at a private hospital employed robotic technology and used the ‘firefly technique’ to remove a tumour from the kidney of a septuagenarian with chronic diabetes, hypertension, and suboptimal renal function.
The position of the tumour in the 71-year-old and his health condition ruled out a conventional or laparoscopic procedure. Doctors at Sai Uro Clinic decided to use robotic technology to excise the tumour from his right kidney. The procedure was necessitated as his left kidney had ceased functioning, and there was the risk of dependence on dialysis.
Vasantharaja Ramasamy, senior consultant uro-oncology, and Aarthy P., robotic surgeon, performed a partial nephrectomy to remove a part of the kidney. They used nephron-sparing surgery to prevent blood from reaching the tumour while letting it flow to the functioning nephrons to maintain the kidney’s filtering mechanism. The patient lost less than 50 ml of blood and did not require intensive care monitoring or dialysis support post-surgery. He was discharged within 48 hours as his kidney functions remained unaffected.
Dr. Vasantharaja, who is also the hospital’s managing director, said the patient’s kidney function was borderline. The tumour measured 3.5 cm. The patient was on regular medication for diabetes and hypertension, and his nephrologist was managing his renal condition conservatively on fluid restriction. “We need to close the main vascular supply to the kidney in any renal surgery to avoid catastrophic bleeding during tumour excision and suturing,” he said, adding that, “In the patient, the main supply could not be closed as it would cut off the blood supply to the only functioning kidney.”
The doctors built a 3D model of the blood supply of the affected kidney and used the ‘firefly technique’, which uses a dye to make the vascular structure visible in fluorescent imaging in real time. “This technology works like how a firefly is seen at night due to its bioluminescence,” the doctor said.
“We use the fluorescent dye to identify the blood vessel supplying the tumour using a special robotic camera and block it. We did not block the main blood supply as is usually done while removing a tumour from the kidney. This can be hazardous in patients with renal failure,” Dr. Vasantharaja added.
