Intraoperative Doppler Verification of Arterial Occlusion in Minimally Invasive Renal Resection

Doppler ultrasonography (DUSG) enables intraoperative assessment of renal perfusion during partial nephrectomy. This study evaluated the feasibility of DUSG and compared its outcomes with indocyanine green (ICG) fluorescence imaging and a control group (CG) without intraoperative perfusion imaging.

We retrospectively analyzed 426 patients undergoing minimally invasive partial nephrectomy between 2018 and July 2025. Ischemia verification was performed using DUSG in 174 patients (41%) and ICG in 29 patients (7%). The CG included 223 patients (52%). Selection of imaging modality depended on the surgeon's preference and intraoperative findings. Perioperative, oncological, and functional outcomes were analyzed using one-way analysis of variance and chi-square tests.

No significant differences were observed in tumor size, BMI, warm ischemia time, blood loss, RENAL score, or complication severity assessed by the Clavien-Dindo classification. Selective clamping and clamp adjustment were significantly more frequent in the DUSG and ICG groups compared with controls (both p < 0.001). Positive surgical margin rates were low and comparable between groups.

Both DUSG and ICG represent safe and effective methods for ischemia verification; however, DUSG offers the advantages of lower cost, wider availability, and no risk of contrast-related adverse reactions, making it a practical option for routine clinical use.