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Green glow helps GRU surgeons define kidney cancer

Thursday, April 18, 2013 6:52 PM
Last updated Friday, April 19, 2013 1:29 AM
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Georgia Rep. Wayne Howard might be the only person who thinks his kidney stones were divine intervention.

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Dr. Martha Terris, the Witherington Distinguished Chair of Urology at Georgia Regents University, explains how surgeons at Georgia Regents University are using a green dye system that glows under certain light to help them better define kidney tumors during robotic surgery, which should aid in their removal.   EMILY ROSE BENNETT/STAFF
EMILY ROSE BENNETT/STAFF
Dr. Martha Terris, the Witherington Distinguished Chair of Urology at Georgia Regents University, explains how surgeons at Georgia Regents University are using a green dye system that glows under certain light to help them better define kidney tumors during robotic surgery, which should aid in their removal.

Howard, D-Augusta, woke up in terrible pain one morning, and an
X-ray discovered the cause was kidney stones. It also found a suspicious spot on a kidney that turned out to be cancer.

“If it had not been for the kidney stones, I would never have known this was there,” Howard said. “I say, thank God for the stone.”

He is also grateful for an innovative surgical technique that aided in the tumor’s removal. Dr. Martha K. Terris, who holds the Witherington Distinguished Chair of Urology at Georgia Regents University, used a dye and fluorescence technique during robotic surgery to better define the tumor and outline what needed to be cut out.

Kidney surgery can be difficult because it is a well-protected organ, she said.

“The kidneys are behind all of the other internal organs. They’re nestled safely between the spine and the back muscles and cradled in the ribs,” Terris said. That meant cutting through a lot of muscle and maybe even removing ribs to work on them, she said.

Robotic and laparoscopic surgeries, which use small incisions and long instruments, allow surgeons to reach into the kidneys with less damage to the body. That presents a problem because the surgeon no longer can use touch to determine the hard tumor from the kidney and it might not be apparent visually, Terris said.

“When you’re trying to preserve part of the kidney and just take the tumor off, it is hard to tell where the tumor starts and the normal kidney begins,” she said.

Using the dye allows doctors to take advantage of the kidney’s natural function to better define the tumor. After the patient is set up for robotic surgery, indocyanine green is injected and allowed to percolate throughout the kidney. After the light is switched to fluorescence, tissue that has absorbed it glows.

“The normal kidney tissue shows up bright green, whereas tumors do not,” Terris said. “Normal kidney filtration filters the green material, whereas the kidney tumor doesn’t have any filtering ability. So we can see where to make our incisions and make sure that we get all of the tumor out. It’s really been a huge improvement.”

Thorough removal is key because surgery is the best chance at a cure and because kidney cancers typically don’t respond well to chemotherapy or radiation, she said.

“It’s really our best shot if we can get the tumor out,” Terris said.

The dye imaging allows the surgeon to do that part of the surgery about 10 to 15 minutes faster, Terris estimated. That is important because while the surgeon is cutting out the tumor, the blood supply to the kidney is clamped off.

“The faster we do that, the less time the kidney’s blood supply is compromised, the better the kidney function will be in the long term,” she said.

Many patients are already at risk for compromised kidney function in the future because of high blood pressure, diabetes or other conditions, so limiting that damage helps, she said.

Howard, the head of the Richmond County legislative delegation, said he feels no ill effects from his surgery or the cancer but that it has made him more aware of his health and he tries to be more careful about diet. He is grateful to God about the place and the timing of his cancer diagnosis.

“It’s obviously not something you want to be diagnosed with,” Howard said. “But if there had to be a time, I’m thankful for (the surgery) being available at the time I needed it.”

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