Broadcaster: Al Jazeera
Year: 2014 (repeat)
In this 11 minute segment from Al Jazeera’s medical science programme The Cure, presenter Rafik Bedair investigated the use of novel technologies to reduce the amount of tissue removed from patients with kidney cancer. Since we have two kidneys, the traditional response to discovery of a tumour in a kidney has been to remove the whole thing (total nephrectomy).
There are several significant downsides to total nephrectomy, including a long recovery time, a large scar and increased risk of subsequent kidney issues now the patient is operating off one kidney not two.
Bedair visits St George’s Hospital in London to observe “robotic firefly surgery” (see this link and this link for more details). He meets Bob Cutts, a patient who has complications due to his “horseshoe kidney” in which his two kidneys have become fused together. To further complicate things, Bob regularly takes the blood-thinning drug warfarin to help with a heart condition. Bob’s urologist plans to use keyhole surgery to carry out a partial nephrectomy.
A combination of a da Vinci surgical robot and injection of a fluorescent dye (known as “firefly”) allows for careful surgery to be conducted. The urologist conducts the operation from a robotic console, where he can toggle between white light and fluorescent mode to maximise the benefits of both views. They can position a plastic loop around blood vessels that they don’t want to cut, both to identify them and also to manoeuvre them out of the way. The dye allows them to see where blood is flowing and they can use this to identify the exact blood vessels they need to clamp to isolate the tumour without causing unnecessary bleeding (when they clamp a vessel going to the tumour it will be less fluorescent relative to neighbouring tissue).
The actual removal of the tumour is then very time-limited in order to minimise damage to the rest of the kidney.
Warning: this clip inevitably includes footage of surgery.
An alternative video on Robotic Partial Nephrectomy using “Firefly” fluorescence is available via this link.