Firefly™技术提高了复杂重建机器人手术的精度

机器人辅助手术正在迅速推进泌尿科手术领域。以前作为开放手术的许多程序，例如输尿管重建，现在可以作为微创机器人程序完成。¹在Pe118金宝搏抽水nn状态健康中，外科医生正在使用萤火虫™荧光成像，用于DaVinci®Xi，该成像与机器人外科系统一体化，进一步优化微创手术。

“萤火虫技术为外科医生提供了在放大的3D场工作的能力，并评估解剖结构的微孔和血管供应，”Dr. Alireza Aminsharifi, urologic surgeon at118金宝搏抽水Penn State Health Milton S. Hershey Medical Center以及泌尿外科，泌尿科肿瘤学和微创手术的副教授Penn State College of Medicine。“It makes the robotic platform well-equipped for technically demanding surgeries, especially for reconstruction of vulnerable urinary tract tissues.”

提高能力

Firefly technology uses near-infrared fluorescence imaging, allowing precise, real-time visualization of anatomic structures and their vascular perfusion during surgery. The surgeon administers indocyanine green dye, which acts as a microvascular contrast agent and appears bright green under the near-infrared fluorescent camera. The dye can be given either intravenously or by injection into the surgical area, enabling the surgeon to delineate both the vascular supply and contours of anatomic structures.

“For example, ureteral reconstruction can be challenging in patients with previous ipsilateral surgery, as normal tissue planes are often disrupted or obliterated, and the ureter is encased in fibrotic tissue,” Aminsharifi said. “With Firefly technology, the surgeon can identify the ureter in its surrounding fibrotic tissues, track the course of the ureter precisely and dissect it safely, without injury to the ureter or surrounding vital structures.”

减少狭窄复发的可能性

传统的输尿管重建会带来额外的挑战，因为鉴定了输尿管狭窄的精确边缘可能是困难的。

“准确定位和切除的网站ureteral stricture cannot be overemphasized. The diseased segment of the ureter should be completely excised or bypassed to prevent stricture recurrence,” Aminsharifi said. “Using intravenous indocyanine green, the surgeon can accurately identify the proximal and distal stricture margins under the camera, because well-perfused tissue appears bright green and poorly perfused tissue appears dark. After excising all nonviable tissue, the surgeon can proceed with reconstruction on viable margins.”

这refore, in addition to greater visualization and precision when used during robotic surgery, Firefly technology offers other benefits.

DA Vinci外科系统的界面允许外科医生根据需要在正常照明和荧光成像模式之间切换。照明器还使用LED技术，从而节省运营费用，较少的灯具更换。

此外，使用萤火虫技术的成像出现在3Dhd质量上，允许外科医生清晰，血管，血流和相关组织灌注的详细视图。

Multiple uses

While the use of Firefly technology in reconstructive urologic procedures is relatively new, it is also useful in other surgical settings, including oncologic robotic procedures. For example, the technology can help surgeons differentiate between cancerous and normal kidney tissue during a robotic partial nephrectomy.

“As a real-time vascular contrast agent, the use of near-infrared fluorescence imaging can be very helpful for selective or super-selective clamping of arterial branches to the kidney tumor,” Aminsharifi said. “This results in minimum ischemia to the normal renal parenchyma.”

最近的研究表明，在部分肾切除术期间使用标准化剂量的吲哚菁绿可以大大降低阳性边缘的速率。2020年的一项研究发现该技术产生了0.3％的正保证金率。²

这些优点以及所有微创机器人手术的好处以及较小的切口和降低的恢复时间 - 导致了改善的患者结果。然而，Firefly技术是一种新技术，需要更多的研究来在泌尿外科和其他机器人手术中建立其位置。

“萤火虫技术在泌尿外科的应用是有前途的，”Aminsharifi说。“但需要进一步调查来改善对这种创新技术的临床价值的理解，并提供其许多福利的证据。”

References

1. Babbar P，Yerram N，Sun A等人。机器人辅助输尿管重建 - 现状和未来方向。泌尿外科Annals.2018 Jan-Mar; 10(1): 7–14. doi: 10.4103/UA.UA_94_17.
2. Sentell KT, Ferroni MC, Abaza R.BJU International.。机器人辅助部分肾切除术期间近红外荧光成像。2020 8月; 126（2）：259-264。DOI：10.1111 / BJU.15089。