Successful Robot-Assisted Resection of a Retroperitoneal Cystic Tumor With Fluorescent Ureteral Stent and Firefly Imaging.

INTRODUCTION

We present a technique that combines a fluorescent ureteral catheter with Firefly near-infrared fluorescence imaging to identify the ureter and avoid injury during robot-assisted resection of a retroperitoneal cystic tumor.

CASE PRESENTATION: Computed tomography revealed a 6-cm retroperitoneal cystic mass anterior to the abdominal aorta near the lower pole of the left kidney that adhered to the left ureter in a 53-year-old man. A fluorescent ureteral catheter was placed preoperatively, and robot-assisted transperitoneal resection was performed. Firefly imaging enabled clear visualization of the ureter, allowing safe dissection and tumor identification. The tumor was excised without cyst rupture. The console time was 4 h 13 min, with minimal blood loss. Pathology confirmed schwannoma.

CONCLUSION

We demonstrated the feasibility and clinical benefits of integrating a fluorescent ureteral catheter with Firefly fluorescence imaging for intraoperative ureteral identification during robot-assisted surgery. This fluorescence-guided approach improves dissection accuracy and helps prevent ureteral injury.