Clinical Benefits of Indocyanine Green Fluorescence in Robot-Assisted Partial Nephrectomy

Abstract

Background: To compare the intraoperative and postoperative outcomes of indocyanine green (ICG) administration in robot-assisted partial nephrectomy (RAPN) and report the differences in the results between patients with benign and malignant renal tumors. Methods: From 2017 to 2020, 132 patients underwent RAPN at our institution, including 21 patients with ICG administration. Clinical data obtained from our institution’s RAPN database were retrospectively reviewed. Intraoperative, postoperative, pathological, and functional outcomes of RAPN were assessed. Results: The pathological results indicated that among the 127 patients, 38 and 89 had received diagnoses of benign and malignant tumors, respectively. A longer operative time (311 vs. 271 min; p = 0.006) but superior preservation of estimated glomerular filtration rate (eGFR) at 3-month follow-up (90% vs. 85%; p = 0.031) were observed in the ICG-RAPN group. Less estimated blood loss, shorter warm ischemia time, and superior preservation of eGFR at postoperative day 1 and 6-month follow-up were also noted, despite no significant differences. Among the patients with malignant tumors, less estimated blood loss (30 vs. 100 mL; p < 0.001) was reported in the ICG-RAPN subgroup. Conclusions: Patients with ICG-RAPN exhibited superior short-term renal function outcomes compared with the standard RAPN group. Of the patients with malignant tumors, ICG-RAPN was associated with less blood loss than standard RAPN without a more positive margin rate. Further studies with larger cohorts and prospective designs are necessary to verify the intraoperative and functional advantages of the green dye.

Robotic versus Laparoscopic Partial Nephrectomy in the New Era: Systematic Review

“…Trifecta is considered a new term to describe the surgical quality that combines the following characteristics: the presence of negative surgical margins, the absence of serious complications, and a ≤30% postoperative estimated glomerular filtration rate (eGFR) reduction [ 28 ]. Trifecta has been widely employed in the literature as a key indicator of PN success; as a consequence, different scoring systems have been proposed including anatomical complexity tumor classifications, which could predict perioperative outcomes [ 31 ].…”

The use of indocyanine green in partial nephrectomy: a systematic review

“…After reviewing full-text, 70 records did not meet our criteria and were therefore excluded. Finally, 14 studies were deemed eligible for qualitative analysis [ 7 – 20 ]. The flow diagram is shown in Figure 1 .…”

“…Thirteen studies in our review provided information for the dosage scheme followed by the surgeons. Six of them were prospective studies [ 7 , 8 , 9 , 13 , 14 , 15 ] and seven were retrospective cohort studies [ 10 , 11 , 12 , 16 , 17 , 18 , 20 ]. An initial bolus dose of 5 mg was administered in 7 studies [ 7 , 9 , 11 , 12 , 13 , 15 , 17 ] while in one study the starting dose was 7.5 mg [ 8 ].…”

“…The reported time interval between injection and fluorescence of the vasculature or the renal parenchyma ranges from five seconds to two minutes [ 7 , 11 , 13 , 15 – 20 ] with one minute considered adequate time in most of the studies. An extra ICG dose after tumor excision and the performance of the renorrhaphy was given by some authors in order to confirm that kidney is fully perfused [ 7 , 8 , 14 , 15 , 16 ].…”

Indocyanine green in minimally and maximally invasive genitourinary cancer surgery

“…1A). Additionally, the use of ICG has the potential to reduce blood loss in malignant renal cell cancers without increasing positive surgical margins [2]. In comparison to intraoperative ultrasonography techniques, ICG may provide a similar delineation between tumour and renal parenchyma, complementing the use of intraoperative ultrasonography.…”