Urology Team Introduces Breakthrough Surgery for Kidney Cancer

Procedure Integrates Fluorescent Imaging and Robotics

golijanin with da vinci robotJames P. Wilmot Cancer Center surgeons were first in the nation to use an infrared imaging technique combined with robot-assisted surgery to remove kidney cancer. The team, led by Dragan Golijanin, M.D., performed robotic laparoscopic partial nephrectomies on patients at Strong Memorial Hospital using the new technology. 

Golijanin, an assistant professor in URMC’s Department of Urology and at the Wilmot Cancer Center, spearheaded research behind the development of the new technique, which illuminates tissues and organs in a completely different way. He worked with experts at Intuitive Surgical, which manufacturers the da Vinci Robotic Surgery System, to adapt the da Vinci system for use in special renal cancer cases as well as other genitourinary malignancies.

The FDA granted approval for the procedure based entirely on the work of Golijanin and fellow urology surgeons Guan Wu, M.D., and Hani Rashid, M.D. Their preliminary study was published in July in the Journal of Urology. URMC has pending patent applications for the technique.

Surgery is usually the first and, in many cases, only course of treatment for renal cell carcinoma. Robot-assisted laparoscopic partial nephrectomy is an emerging technique that has gained acceptance for tumors less than 5 centimeters. Partial nephrectomy removes the cancer while preserving as much healthy, unaffected kidney tissue, and kidney function, as possible. However, robotic surgery carries a long learning curve for surgeons, who are challenged to remove tumors with adequate margins while preserving healthy tissue amid a complex vascular supply within the kidney.

Until now, the best existing technology required the surgeon in the operating room to toggle between two systems – a console with “arms” to control the robotic instruments, and the imaging system that provided views of the surgical site. Typically, the patient is injected with a dye that fluoresces green when exposed to infrared light, which defines and illuminates the operative area in detail for two to five minutes at a time. The challenge for the doctor has been to move relatively quickly between the instrument console and a projection of the images that are often displayed across the room. 

“This can be cumbersome and time-consuming, especially in more challenging cases,” said Golijanin.

The new technology, developed with Intuitive, of Sunnyvale, Calif., integrates the fluorescent imaging system and the surgical console into one system. The multimodal imaging allows the surgeon to turn his or her attention back and forth from different types of images to the surgical tools, without stepping away from the console. Existing da Vinci systems can be upgraded with the new imaging technology.

“This combination of new and existing technology offers great potential and opens the door to being able to provide the option of minimally invasive surgery to a greater percentage of patients, and to preserve kidney function in a greater percentage of patients,” said Golijanin. “Through further study we’ll fine tune the process to determine the optimal dosing of the infrared dye, the exact timing of the intravenous injection, and determine whether this new imaging technology actually improves outcomes, both in terms of cancer prognosis and the preservation of kidney function. By simplifying the imaging process, it will also assist young urologists and decrease the number of cases needed to master robotic laparoscopic partial nephrectomy.”

Results from Golijanin’s study showed that in 11 patients, the kidney tumors and surrounding renal arteries were clearly identified, and malignant tissue was differentiated from normal tissue. Surgeons expect the new system will serve as an adjunct to existing imaging, allowing them to achieve better resection margins around the cancer with fewer bleeding complications, Golijanin said.

The procedure will be used within the URMC Center for Robotic Surgery and Innovation, led by Jean Joseph, M.D., and Edward Messing, M.D., chair of Urology at URMC. 

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