Indocyanine-Green-Guided Partial Nephrectomy: A Narrative Review Addressing Protocol Heterogeneity, Perioperative...

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Partial nephrectomy is standard for localized renal tumors, but challenges exist in tumor localization, perfusion evaluation, and vascular control.
• Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) is an emerging adjunct to enhance intraoperative visualization and guide surgical strategies.
• Inconsistent clinical results highlight a need for standardized protocols to improve the reproducibility of ICG-NIRF in renal surgery.

Purpose of the Study:

• To synthesize comparative evidence on the benefits and limitations of ICG-NIRF in partial nephrectomy.
• To identify sources of methodological heterogeneity in current studies.
• To propose minimum criteria for standardizing ICG use in renal surgery.

Main Methods:

• A narrative review of comparative clinical studies published since 2012 was conducted.
• Searches were performed on PubMed using terms related to NIRF, ICG, and partial nephrectomy.
• Key endpoints analyzed included warm ischemia time, surgical margins, perioperative outcomes, and renal function.

Main Results:

• ICG-NIRF facilitates real-time visualization of renal perfusion and vascular anatomy, potentially improving tumor-parenchyma contrast for selective clamping.
• Studies report minor reductions in warm ischemia time and modest short-term improvements in estimated glomerular filtration rate (eGFR).
• No consistent differences were found in positive surgical margins, major complications, or oncologic outcomes; long-term functional benefits remain unproven.

Conclusions:

• ICG-NIRF serves as a valuable intraoperative tool for perfusion assessment and vascular control in partial nephrectomy.
• Current evidence does not support long-term functional or oncologic advantages over standard surgical techniques.
• Standardization of protocols, quantitative metrics, and robust trials with long-term endpoints are crucial for advancing ICG-NIRF applications.