BJUI Compass (Apr 2024)

Indocyanine green‐marked fluorescence‐guided off‐clamp versus intraoperative ultrasound‐guided on‐clamp robotic partial nephrectomy: Outcomes on surgical procedure

  • Federica Mazzoleni,
  • Davide Perri,
  • Andrea Pacchetti,
  • Elena Morini,
  • Lorenzo Berti,
  • Umberto Besana,
  • Eliodoro Faiella,
  • Lorenzo Moramarco,
  • Domiziana Santucci,
  • Davide Fior,
  • Giorgio Bozzini

DOI
https://doi.org/10.1002/bco2.307
Journal volume & issue
Vol. 5, no. 4
pp. 466 – 472

Abstract

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Abstract Objectives To compare surgical and functional outcomes between off‐clamp robot‐assisted partial nephrectomy with indocyanine‐green tumour marking through preliminary superselective embolization and on‐clamp robot‐assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass. Material and methods One hundred and forty patients with a single renal mass underwent indocyanine‐green fluorescence‐guided off‐clamp robot‐assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound‐guided on‐clamp robot‐assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions. Results Mean tumour size was 24 versus 25 mm in Group A versus Group B (p = 0.19). Mean operative time was 86.5 versus 121.8 min (p = 0.02), mean blood loss was 72.8 versus 214.2 mL (p = 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p = 0.04) in Group A versus Group B. One‐month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group. Conclusions Preoperative superselective embolization of a renal mass with indocyanine‐green before off‐clamp robot‐assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on‐clamp intraoperative ultrasound‐guided robot‐assisted partial nephrectomy. A longer follow‐up is needed to establish the effect on renal function.

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