This case demonstrates the utility of indocyanine green (ICG) fluorescence-guided robotic-assisted partial cystectomy in a pediatric patient with an inflammatory myofibroblastic tumor (IMT) in the bladder. ICG, a fluorescent dye, is commonly used in various urologic surgeries to assess vascularization or delineate tissue structures, facilitated by the Firefly near-infrared fluorescence (NIRF) feature of the da Vinci robotic system. In this case, a 2 cm nodular tumor at the dome of the bladder, refractory to systemic steroid therapy, was identified in the patient. After performing rigid cystoscopy with a 9.5 French pediatric cystoscope, 3 mL of intradetrusor ICG was injected circumferentially around the tumor using a 23-gauge needle. The robot was then docked, and Firefly NIRF allowed precise visualization of the ICG-injected areas, enabling the surgeon to mark the tumor margins with cautery. A robotic-assisted partial cystectomy was performed, and the bladder was sutured in two layers using 3-0 barbed sutures in a running pattern. A leak test with 200 mL of normal saline confirmed no leakage.
Pathology results revealed a 1.1 cm IMT with atypical spindle cell and eosinophilic proliferation, and the surgical margins were negative, ensuring complete tumor removal. The patient was discharged the day after surgery with a Foley catheter, which was removed 10 days later. A follow-up renal bladder ultrasound was scheduled to monitor the patient’s progress. This case highlights how the intradetrusor injection of ICG under NIRF can effectively guide tumor margin identification and enhance the precision of robotic-assisted partial cystectomy, making it a valuable tool in complex pediatric urologic surgeries.
