Selective renal artery clamp during robot assisted partial nephrectomy: The use of indocyanine green

Abstract

Introduction: We aim to illustrate in a step-by-step manner the use of indocyanine green during selective clamp robot-assisted partial nephrectomy (RAPN). Patient and surgical procedure: A 52-year-old female referred to our Institution with a history of an asymptomatic, accidental renal mass at the lower pole of the right kidney. The diameter of the renal mass was 3 cm at preoperative imaging, with a PADUA score of 7. We performed right transperitoneal RAPN with selective ischemia. Indocyanine green was used to control ischemic area. After tumor enucleo-resection a medullary and cortex suture was performed. At the end of the procedure a hemostatic agent was applied. Results: Intraoperative blood-loss was 100 ml, with an ischemia time of 14 min. Postoperative Hb was 11.3 g/dL and creatinine 0.7 mg/dL. On the third postoperative day the drain was removed and in the same day the patient was discharged. No postoperative complications or recurrences were found during the follow-up. Conclusion: Intraprocedural ICG administration represents a reliable method to provide enhanced insight into kidney vascularization and could represent a safe and useful tool in cases when vascular anatomy is challenging.

Keywords

• Small renal masses
• Nephron sparing surgery
• Indocyanine green
• Kidney cancer