Near-Infrared Fluorescence Imaging with Indocyanine Green for Robot-Assisted Partial Nephrectomy: A Systematic Review...

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Kidney tumors (KT) often necessitate partial nephrectomy (PN) to preserve renal function.
• Robot-assisted partial nephrectomy (RAPN) is a minimally invasive approach for KT treatment.
• Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is being explored to enhance surgical precision during RAPN.

Purpose of the Study:

• To analyze the impact of NIRF using ICG on perioperative and long-term outcomes in patients undergoing RAPN for KT.
• To evaluate the effectiveness of NIRF-ICG in improving functional and oncological results during RAPN.

Main Methods:

• A comprehensive literature search was conducted on PubMed, EMBASE, and Scopus up to September 12, 2023.
• Included observational studies comparing RAPN with and without NIRF-ICG in KT patients.
• Meta-analysis of perioperative outcomes (e.g., warm ischemia time, postoperative eGFR) and oncological outcomes (e.g., positive surgical margins, recurrence rates).

Main Results:

• Eight prospective studies involving 535 patients were analyzed (212 in ICG group, 323 in No ICG group).
• The NIRF-ICG group demonstrated a significantly shorter warm ischemia time (WMD = -2.05, p=0.011) and improved postoperative eGFR (WMD = 7.67, p=0.002).
• No significant differences were observed in other perioperative outcomes, positive surgical margins, or tumor recurrence rates between the groups.

Conclusions:

• NIRF with ICG during RAPN significantly improves functional outcomes, specifically reducing warm ischemia time and enhancing postoperative kidney function.
• NIRF-ICG does not appear to influence oncological outcomes, such as positive surgical margins or tumor recurrence rates.
• NIRF-ICG is a valuable adjunct in RAPN when the primary goal is nephron preservation and maintaining renal function.