Alessandro Veccia1, Alessandro Antonelli2, Lance J Hampton3, Francesco Greco4, Sisto Perdonà5, Estevão Lima6, Ashok K Hemal7, Ithaar Derweesh8, Francesco Porpiglia9, Riccardo Autorino10. 1. Division of Urology, VCU Health System, Richmond, VA, USA; Urology unit, ASST Spedali Civili Hospital, Brescia Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy. 2. Urology unit, ASST Spedali Civili Hospital, Brescia Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy. 3. Division of Urology, VCU Health System, Richmond, VA, USA. 4. Division of Urology, Humanitas Gavazzeni, Bergamo, Italy. 5. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy. 6. Urology Department, Hospital de Braga, Braga, Portugal. 7. Department of Urology, Wake Forrest University, Winston Salem, NC, USA. 8. Division of Urology, UCSD Health System, La Jolla, CA, USA. 9. Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 10. Division of Urology, VCU Health System, Richmond, VA, USA. Electronic address: ricautor@gmail.com.
Abstract
CONTEXT: The use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN). OBJECTIVE: To perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF). EVIDENCE ACQUISITION: A systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software. EVIDENCE SYNTHESIS: Six comparative studies were identified. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No significant difference was identified between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular filtration rate (eGFR) values in the NIRF-RAPN group at short-term (1-3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26ml/min; 95% confidence interval [CI]: 6.46, 12.06; p<0.001). In two studies, a renal scan-based assessment of split eGFR was available, and pooled analysis revealed higher split eGFR for NIRF-RAPN (WMD: 7.91ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower Δ % between preoperative and 1-mo eGFR (WMD: -7.84%; 95% CI: -8.85, -6.83; p<0.00001). CONCLUSIONS: Current evidence regarding the use of NIRF-guided selective clamping during RAPN is based on a limited number of studies from high-volume institutions. Notwithstanding these limitations, NIRF-RAPN can be safely performed, and it might offer better short-term renal functional outcomes. It remains to be determined whether this can ultimately translate into a clinical benefit for patients undergoing RAPN, especially in the long term. PATIENT SUMMARY: We assessed the outcomes of robot-assisted partial nephrectomy (RAPN) performed with or without the use of near-infrared fluorescence (NIRF) imaging. NIRF-RAPN appeared to be a safe procedure with potential better short-term functional outcomes. Published by Elsevier B.V.
CONTEXT: The use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN). OBJECTIVE: To perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF). EVIDENCE ACQUISITION: A systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software. EVIDENCE SYNTHESIS: Six comparative studies were identified. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No significant difference was identified between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular filtration rate (eGFR) values in the NIRF-RAPN group at short-term (1-3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26ml/min; 95% confidence interval [CI]: 6.46, 12.06; p<0.001). In two studies, a renal scan-based assessment of split eGFR was available, and pooled analysis revealed higher split eGFR for NIRF-RAPN (WMD: 7.91ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower Δ % between preoperative and 1-mo eGFR (WMD: -7.84%; 95% CI: -8.85, -6.83; p<0.00001). CONCLUSIONS: Current evidence regarding the use of NIRF-guided selective clamping during RAPN is based on a limited number of studies from high-volume institutions. Notwithstanding these limitations, NIRF-RAPN can be safely performed, and it might offer better short-term renal functional outcomes. It remains to be determined whether this can ultimately translate into a clinical benefit for patients undergoing RAPN, especially in the long term. PATIENT SUMMARY: We assessed the outcomes of robot-assisted partial nephrectomy (RAPN) performed with or without the use of near-infrared fluorescence (NIRF) imaging. NIRF-RAPN appeared to be a safe procedure with potential better short-term functional outcomes. Published by Elsevier B.V.
Entities:
Keywords:
Indocyanine green; Near-infrared fluorescence; Partial nephrectomy; Robotic surgery
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