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Biophotonics-Intraoperative Guidance During Partial Nephrectomy: A Systematic Review and Meta-analysis.

Luisa Egen1, Greta S Demmel1, Maurizio Grilli2

  • 1Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.

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|January 26, 2024
PubMed
Summary
This summary is machine-generated.

Biophotonics techniques like near-infrared fluorescence (NIRF) imaging can aid partial nephrectomy (PN) by reducing warm ischemia time. However, high-level evidence confirming benefits like improved functional outcomes is still needed.

Keywords:
BiophotonicsIntraoperative guidanceKidney cancerPartial nephrectomySelective clamping

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Area of Science:

  • Surgical Oncology
  • Medical Imaging
  • Biotechnology

Background:

  • Partial nephrectomy (PN) offers improved outcomes for kidney cancer but requires high precision.
  • Biophotonic techniques provide real-time intraoperative guidance, potentially enhancing PN precision and outcomes.
  • High-level evidence on the value of biophotonics in PN is currently limited.

Approach:

  • A comprehensive literature search was conducted using PICO criteria, focusing on studies published before October 2022.
  • 35 studies were included for qualitative analysis, encompassing various biophotonic modalities like NIRF, hyperspectral imaging, and others.
  • A meta-analysis of seven studies specifically examined NIRF-guided PN with selective arterial clamping.

Key Points:

  • Near-infrared fluorescence (NIRF) imaging with indocyanine green was the most studied biophotonic technique.
  • NIRF-guided PN significantly reduced warm ischemia time compared to conventional methods.
  • No significant differences were observed in transfusion rates, positive surgical margins, or major complications.
  • Short-term functional outcomes (GFR) favored NIRF-PN, but this advantage diminished at long-term follow-up.
  • One included randomized controlled trial did not confirm these positive findings.

Conclusions:

  • Biophotonics encompasses diverse imaging modalities that aid intraoperative decision-making during PN.
  • Clinical implementation and cost-effectiveness of biophotonic techniques require further investigation.
  • Future research should address the practical integration and economic viability of these advanced surgical tools.