Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: a single-surgeon matched-pair study.

PURPOSE: To present a single-surgeon matched-pair analysis to show the feasibility of combining the technique of selective clamping with usage of near-infrared fluorescence imaging in robot-assisted partial nephrectomy and to investigate short-term renal function outcomes.
METHODS: Twenty-two patients underwent selective clamping partial nephrectomy with the application of indocyanine green (ICG). Out of this cohort, a matched-pair analysis for R.E.N.A.L. nephrometry parameter was employed for 15 exactly matching partners. Demographic, surgical, pathological and kidney function data were collected for the initial cohort, and matched-pair comparison was made between the subgroups retrospectively.
RESULTS: Robot-assisted partial nephrectomy without clamping of the hilum was possible in 21 patients; in one patient, main artery clamping was necessary due to bleeding. Mean clinical tumor size was 37.7 mm. Mean selective clamping ischemia time was 11.6 min with an estimated blood loss of 347 ml. No intraoperative complications occurred, and postoperative complications (n = 4), including two major urological (urinoma, late-onset acute hemorrhage) complications, were found. There were no side effects of ICG administration. Matched-pair analysis for 15 patients showed similar demographic and surgical data without any significant differences in tumor characteristics. Comparing short-term renal function outcomes, significantly decreased estimated glomerular filtration rate reduction in the selective clamping group with an absolute loss of 5.1 versus 16.1 ml/min in the global ischemia cohort (p = 0.045) could be observed.
CONCLUSIONS: Robot-assisted partial nephrectomy with selective clamping of the tumor feeding vascular branches is a promising technique for reduced ischemic renal trauma. This may lead to improved kidney function preservation.