Background: Firefly fluorescence imaging technology has been used duringrobotic assisted urological procedures, commonly for partial nephrectomies.In this study, we report on the use of this technology for roboticassisted partial cystectomy for bladder tumors and ureteral reconstructiveprocedures.Methods: Firefly flourescence imaging technology has been used sinceNovember 2012 at our institution. It has been used most commonly forrobotic assisted partial nephrectomies. We have applied this technologyduring partial cystectomies and ureteral reconstructive procedures. Duringthese procedures we either do a flexible cystoscopy (for a partial cystectomy)or a flexible ureteroscopy (for ureteral reconstruction). Once thelesion is identified, we point at it endourologically, and turn-on the Fireflytechnology on the robotic console. This technique allows us to visualizethe endoscopic light in green color, and identify the exact point wherethe lesion is located. Patient demographics, perioperative outcomes andcomplications were analyzed.Results: 2 patients were performed using this technique. In one case, thepatient (61 y.o. male, BMI of 31) had a double right ureteral strictureabove the iliac vessels that had been dilated and stented multiple times.A flexible ureteroscopy was used to identify the areas of stricture. Fireflytechnology was used to define were the resection of the ureter was goingto be performed. For this case, a robotic assisted boari flap was performed.Robotic console time was 170 min, estimated blood loss was 50 cc, hospitalstay was 3 days, and JP drain time was 2 days. In the second case, thepatient had a bladder tumor in the dome compatible with either a bladderadenocarcinoma versus a urachal cyst remanent. A flexible cystoscopywas performed during the robotic assisted partial cystectomy plus urachalresection. Robotic console time was 80 min, estimated blood loss was25 cc, hospital stay was 2 days, and JP drain time was 2 days. Clear cutborders of resection were identified during both procedures. At 3 months(mean time) followup, there was no complications.Conclusions: Firefly fluorescence imaging technology to assist in localizinga lesion in the bladder or the ureter, proofed to be effective during both therobotic assisted partial cystectomy and the ureteral reconstruction.
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