HYGEIA: New Nephron-Sparing Renal Tumor Removal Technique Using the da Vinci Xi Robotic System with Integrated Firefly Technology

07 May 2018

Integrated Firefly technology was used for the first time in Greece to perform partial nephrectomy, with the latest generation da Vinci Xi robotic system at HYGEIA Hospital.

Specifically, ICG fluorescent dye was administered intravenously to a 61-year-old patient with a 4.5 cm tumor in the right kidney, perioperatively. Then using the da Vinci Xi robotic system with integrated Firefly technology available at HYGEIA Hospital, it was possible to remove the renal tumor with healthy margins and without incisions, while the remaining renal parenchyma was spared.

Firefly technology, which was applied for the first time in Greece in a partial nephrectomy procedure, requires the intravenous administration of fluorescent dye (ICG), which binds to the plasma proteins. When stimulated by the laser beam through the da Vinci system, it emits light in the near-infrared range. Using this technology, it is possible to distinguish in real-time between the healthy renal tissue, which absorbs the fluorescent dye, and the tumor, which appears darker. The Firefly system also makes it easier to identify the renal arteries.

The procedure was performed by the Director of the HYGEIA Hospital 2nd Urology Clinic, Dr.  Emanuel Panagiotou, urologist, and his team (urologists Dr.  Alexandros Papadopoulos and Dr. Alexandros Mokakos and anesthesiologist Dr.  Kalliopi Panagiotou).

As Dr. Panagiotou noted, “While total nephrectomy had been proposed to the patient in other hospitals, due to the proximity of the tumor to renal vessles, at HYGEIA we were able to use this technique to resect the renal tumor with healthy margins. That is, using the da Vinci system, we performed a robotic-assisted partial nephrectomy through small laparoscopic incisions, which would have otherwise required total nephrectomy.  To a great extent, renal tumors nowadays are a random finding during an imaging scan (ultrasound, CT or MRI). According to the American Urological Association and the European Association of Urology Guidelines, the treatment of choice is partial nephrectomy. This means removing the part with the tumor, while sparing the remaining renal parenchyma, provided this is possible based on the size and position of the tumor, as well as the surgeon’s experience.”