Firefly Sheds New Light on BBC Surgeries

August 14, 2012

Remember when you were a kid during the summer months, and right around dusk, you chased and caught fireflies and put them into a jar that had a lid that had holes poked in it?  The fluorescent green-yellow blinking flare that those lightning bugs emitted was fascinating.    

Today, that glow shows up in the operating room at Bronson Battle Creek in a new surgery technique for patients diagnosed with kidney tumors.  That illuminating procedure is called the daVinci Si HD ‘Firefly.’  

Dr. Kevin Brewton, an urologist and member of the BBC medical staff is the first physician in Southwest Michigan to use this minimally invasive surgery technology for a partial nephrectomy (removal of ‘part’ of a kidney instead of the entire organ).  

Bronson Battle Creek is the only hospital in this part of Michigan that has adopted the ‘Firefly’ fluorescence imaging technology. 

“The daVinci Si ‘Firefly’ robotic surgery gives our surgeons an even higher flexibility and greater precision in treating their patients who have kidney tumors,” said Dr. Brewton. “The growth of our robotic surgery program at BBC has helped us to provide the very latest advances in robotics to better serve those who entrust their health to us.  We were first with offering the single-incision procedure for gallbladder surgery; we now lead the way in minimally invasive techniques for kidney surgeries.”

What makes the ‘Firefly’ so unique?  The robotic surgery system is used to identify clear margins of kidney tumors and more accurately distinguishing critical vessels and tissues during surgery. The specially designed camera and endoscopes (instruments used to visualize the interior of an organ like the kidney) allow surgeons to capture images of tissue and surrounding blood vessels by injecting a unique fluorescence dye that is activated by near-infrared light.  In addition to standard real-time images of the surgical field, the camera can switch to view the images of tissue and surrounding blood vessels.

"The addition of the ‘Firefly’ fluorescence imaging in our robotic surgery program greatly improves our ability to remove kidney tumors when before we might have had to remove the entire organ, “ added Thomas F. Ignaczak, M.D., BBC vice president of medical affairs.  "’Firefly,’ which basically uses a dye that lights up in what some might refer to as ‘firefly green’ when using a specialized fluoroscopic camera, can show us the difference between cancerous and healthy tissue. It illuminates parts of the kidney and its blood supply that we couldn't see this well before."

During surgery, urologists like Dr. Brewton use the daVinci ‘Firefly’ system at three stages of the procedure. First, the anesthesiologist injects a dye into the IV (an apparatus used to administer something into a vein), which offers a detailed picture of the blood supply to the kidney.

As many as 25 percent of patients might have extra renal arteries that are not always obvious on a CT (computerized tomography) scan or MRI (magnet resonance imaging), so the ‘Firefly’ can help surgeons see these arteries. This helps the urologist ensure that all of the blood supply to the kidney is accounted for and controlled prior to the removal of the tumor, which can decrease blood loss.

The second injection of dye helps the surgeon tell the difference between a cancerous tissue and a normal kidney tissue, which allows for better tumor removal and potentially a lower risk of leaving any cancer behind. 

Finally, after the tumor has been removed and the kidney has been repaired, the dye can again be injected to ensure that the blood supply to the kidney has been properly restored.

Fluorescence imaging technology, coupled with the real-time, three-dimensional daVinci Si surgical system, can result in a higher quality of life and documented long-term survival benefits for patients with kidney tumors.

Besides the known benefits of robotic minimally invasive surgery—including smaller incisions, less blood loss, less postoperative pain, shorter hospital stays, and earlier returns to normal lifestyle—the addition of the ‘Firefly’ system can improve patient outcomes even further. 

"Our ability to better distinguish between tumor tissue and normal kidney tissue may lead to a lower risk of leaving any tumor behind, and therefore offer better long-term cancer survivorship," said Dr. Brewton.

About four out of five patients with small renal masses have their entire kidney removed, a procedure called a nephrectomy. Studies suggest that patients treated with a radical nephrectomy experience more cardiovascular events and an increased mortality rate compared with patients treated with a partial nephrectomy. In addition, patients receiving a partial nephrectomy are three times less likely to develop chronic kidney disease.

According to the American Cancer Society, kidney cancers are among the 10 most common cancers among both men and women. The ACS estimates that more than 60,000 new cases of kidney cancer will occur in 2012; about 13,500 people will die from the disease.

Bronson Battle Creek has more multi-trained general surgeons using the daVinci robotics than any other facility in Southwest Michigan.  The robotic technology at BBC is being used in thoracic, colorectal, gynecological, urological surgeries, and in more general surgeries such as gallbladder removal.  

Bronson Battle Creek is a 218-bed hospital that provides full outpatient and inpatient acute care including robotic surgery, diagnostics, and rehabilitation services; 100% all private rooms.  It also offers world-class diagnostic capabilities including PET/CT imaging, freestanding ‘open’ and traditional MRI, CT (16- and 64-slice), and 3.0 Tesla MRI.  Bronson Battle Creek has been recognized nationally as one of the safest hospitals, and has been a leader in the development of electronic health records as evidenced by multiple honors as one of America’s ‘most wired’ and ‘most wireless’ hospitals. The Commission on Cancer of the American College of Surgeons recognizes the Bronson Battle Creek Cancer Care Center as a Comprehensive Community Cancer Program, and the only hospital in Michigan to receive the CoC’s Outstanding Achievement Award three times in a row. Specialty services include the county’s largest accredited sleep center and a wound-healing center with hyperbaric oxygen therapy.


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