One of the biggest advantages of robotic surgery is enhanced vision due to the magnification, lighting, and lack of bleeding. Firefly fluorescence imaging takes this a step further by giving the surgeon “night-vision” abilities. Typically, a special “dye” is injected into a patient’s veins. Moments later, certain anatomic structures will light up bright green when viewed under near-infrared light. The surgeon has the ability to toggle between near-infrared light and normal white light.
A relatively new application of this technology can come in handy for treating strictures (scar tissue) of the ureter. The ureter is the tube that carries urine from the kidney to the bladder. When either end of this tube becomes narrowed, the surgeon can easily identify the location of the scar tissue using neighboring anatomic landmarks. However, when a place in the middle is affected, it can be very difficult to determine the location of the blockage. This is where some ingenuity comes in handy.
Just prior to starting the robotic procedure, the urologist places a cystoscope into the bladder. The fluorescent dye can then be squirted into the opening of the ureter. The normal lining of the ureter will then absorb the dye much better than any area containing scar tissue. During the subsequent reconstruction, the surgeon can identify the section that needs to be removed. If the remaining cut ends are bright green, the surgeon can be confident that the reconstruction will contain healthy tissue, thereby minimizing future scar tissue formation. The photos demonstrate a reconstructive surgery under both white light and near-infrared light.
Robotic surgery continues to add enhancements to aid in the surgeon and patient success. In the near future, this technology will be combined with using a patient’s MRI or CT image that can be superimposed on the visualized anatomy during the surgery in real time. The sky is the limit.