Robotic Partial Nephrectomy with Indocyanine Green Fluorescence Navigation.

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Partial nephrectomy (PN) is a standard treatment for localized renal tumors.
• Intraoperative imaging, like indocyanine green (ICG) fluorescence, can enhance PN outcomes.
• Robotic PN offers minimally invasive advantages for kidney tumor removal.

Purpose of the Study:

• To evaluate the efficacy of robotic partial nephrectomy using indocyanine green (ICG) fluorescence imaging.
• To assess the impact of ICG navigation on surgical precision and renal function preservation.
• To determine the safety and oncological outcomes of ICG-enhanced robotic PN.

Main Methods:

• Retrospective analysis of 37 patients undergoing robotic PN with ICG fluorescence imaging between April 2015 and May 2019.
• Intravenous administration of 5 mg ICG for real-time fluorescent imaging during surgery.
• ICG use guided by tumor complexity (R.E.N.A.L. nephrometry score, unfavorable anatomy).
• Focus on superselective clamping of tumor-supplying renal artery branches.

Main Results:

• ICG facilitated precise detection of tissue perfusion borders and superselective arterial clamping in 25 cases.
• Mean surgery time was 133 minutes, with a mean estimated blood loss of 190 mL.
• Mean warm ischemia time was 14 minutes; favorable renal function was observed with superselective clamping.
• Low complication rates (2 Grade II, 1 Grade III Clavien-Dindo).

Conclusions:

• Indocyanine green (ICG) fluorescence imaging is a valuable tool for robotic partial nephrectomy.
• ICG enhances the ability to perform superselective clamping of tumor vessels, preserving renal function.
• Robotic PN with ICG navigation demonstrates acceptable oncological results and a favorable safety profile.