Selective clamping during laparoscopic partial nefrectomy: the use of near infrared fluorescence guidance

Near infrared fluorescence (NIRF) is being investigated as a helpful tool to enhance segmental arterial clamping in robotics. Available experiences with NIRF during standard laparoscopy are anecdotal. The aim of the study was to perform a single-center feasibility and results analysis of laparoscopic partial nephrectomy (LPN) performed using NIRF-guided selective clamping.

May 2016-December 2016: 15 patients diagnosed with a renal mass suitable for nephron-sparing approach consecutively underwent LPN with NIRF-guidance technique. Demographic data, tumor characteristics; perioperative data; functional data; pathologic data; postoperative complications as classified according to the Clavien system were prospectively collected. Serum creatinine (SCr) and eGFR were assessed by serial measurements; 99mTc-MAG-3 nuclear renal scan was performed too. The measures were conducted preoperatively and at the 3rd postoperative month.

No complications were recorded. Use of NIRF guidance did not influence the safety of the procedure. Operative time was not significantly increased with respect to the medians reported in the literature for LPN. Blood losses were negligible. NIRF-guidance allowed for successful selective clamping in 11 cases (73.3%). In one case NIRF guidance allowed for the super-selective closing of the tumor-feeding artery. In 4 cases (26.7%) selective ischemia was impossible and clamping of the main renal artery was chosen.

NIRF-guidance was successfully applied during laparoscopic PN, offering the surgeon additional information about kidney anatomy and perfusion. Our experience demonstrated the potential benefits of the new technology. The clinically relevance of selective clamping on functional outcomes is still a matter of debate.