Graziano Vignolini1, Francesco Sessa1,2, Isabella Greco1, Gianmartin Cito1, Davide Vanacore1, Andrea Cocci1, Maurizio Sessa3,4,5, Vieri Grandi6, Alessandro Pili1, Saverio Giancane1, Mauro Gacci1, Arcangelo Sebastianelli1, Vincenzo Li Marzi1, Alberto Breda7, Riccardo Campi8,2, Sergio Serni1,2. 1. Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy. 2. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 3. L. Donatelli Section of Pharmacology, Pharmacovigilance and Pharmacoepidemiology Regional Center of Campania, Naples, Italy. 4. Department of Experimental Medicine, L. Vanvitelli University of Campania, Naples, Italy. 5. Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark. 6. Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. 7. Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain. 8. Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy - riccardo.campi@gmail.com.
Abstract
BACKGROUND: The aim of this paper is to report the first preliminary experience with intraoperative indocyanine green (ICG) fluorescence videography (IFV) to assess graft and ureteral reperfusion during robot-assisted kidney transplantation (RAKT). METHODS: We prospectively collected data from consecutive patients undergoing RAKT and IFV from living-donors at our Institution between January 2017 and April 2018. RAKT was performed following the principles of the Vattikuti-Medanta technique. ICG was injected intravenously after vascular anastomoses to quantitate graft and ureteral fluorescence signal. The signal intensity within selected intraoperative snapshots was evaluated for renal parenchyma, ureter and vascular anastomoses. A systematic review of the English-language literature about the topic was performed according to the PRISMA statement recommendations. RESULTS: Six patients were included. Neither conversions to open surgery nor major intra- or postoperative complications were recorded. At a median follow-up of 12 months (IQR 8-13), median estimated glomerular filtration rate was 64.2 mL/min/1.73 m2 (IQR 45.3-98.4). Intraoperative quantitative assessment of ICG fluorescence was successful in all patients. Of the five studies selected by our review, mostly prospective studies, all including open KT series. Yet, most studies were limited by lack of quantitative measures of IFV fluorescence. CONCLUSIONS: IFV during RAKT is feasible and safe and provides a reliable assessment of graft reperfusion. Larger studies are needed to standardize the technique and to evaluate the association between fluorescence signal, ultrasound parameters and postoperative kidney function.
BACKGROUND: The aim of this paper is to report the first preliminary experience with intraoperative indocyanine green (ICG) fluorescence videography (IFV) to assess graft and ureteral reperfusion during robot-assisted kidney transplantation (RAKT). METHODS: We prospectively collected data from consecutive patients undergoing RAKT and IFV from living-donors at our Institution between January 2017 and April 2018. RAKT was performed following the principles of the Vattikuti-Medanta technique. ICG was injected intravenously after vascular anastomoses to quantitate graft and ureteral fluorescence signal. The signal intensity within selected intraoperative snapshots was evaluated for renal parenchyma, ureter and vascular anastomoses. A systematic review of the English-language literature about the topic was performed according to the PRISMA statement recommendations. RESULTS: Six patients were included. Neither conversions to open surgery nor major intra- or postoperative complications were recorded. At a median follow-up of 12 months (IQR 8-13), median estimated glomerular filtration rate was 64.2 mL/min/1.73 m2 (IQR 45.3-98.4). Intraoperative quantitative assessment of ICG fluorescence was successful in all patients. Of the five studies selected by our review, mostly prospective studies, all including open KT series. Yet, most studies were limited by lack of quantitative measures of IFV fluorescence. CONCLUSIONS: IFV during RAKT is feasible and safe and provides a reliable assessment of graft reperfusion. Larger studies are needed to standardize the technique and to evaluate the association between fluorescence signal, ultrasound parameters and postoperative kidney function.