The impact of indocyanine green on partial nephrectomy perioperative outcomes

We conducted a retrospective analysis of the impact of indocyanine green (ICG) on perioperative outcomes in partial nephrectomy. The utility of ICG in partial nephrectomy remains unclear. We performed a retrospective cohort study of all patients at a single institution who underwent laparoscopic or robotic partial nephrectomy in 2014-2019. Some surgeons used ICG while others did not. Outcomes of interest were estimated blood loss, positive surgical margins, ischemia time, and postoperative kidney function. We used multivariate regression to assess ICG use and outcomes. We identified 150 patients meeting inclusion criteria. The majority of cases (58%) used ICG. Patients who did and did not receive ICG were similar in age, sex, and histologic subtype. Median estimated blood loss was 100 mL (IQR 50-200), 9% had a positive surgical margin, and median ischemia time was 21 min (IQR 16-26). Of those with renal function follow-up, 17% had increased chronic kidney disease stage and mean percent creatinine change was + 4.7 ± 14.9%. On multivariate analysis, ICG use was associated with change in CKD stage (OR 9.9, 95% CI 1.0-93.9, p = 0.05). It was not associated with positive surgical margin status (OR 1.20, 95% CI 0.38-3.85, p = 0.755), percent change creatinine (beta 5.18, 95% CI -1.87-12.23, p = 0.155), ischemia time (beta 0.86, 95% CI - 1.38-3.09, p = 0.45), or EBL (beta - 0.13, 95% CI - 0.53-0.28, p = 0.53). We observed a difference in CKD change according to ICG in partial nephrectomy, but not other perioperative outcomes. ICG may have impacted surgical decision-making in unmeasured ways but did not significantly affect perioperative outcomes.