3D virtual models plus near-infrared fluorescence guidance for the best selective clamping strategy during robotic partial nephrectomy

Abstract

Objective

Indocyanine green (ICG) and Three-dimensional virtual models (3DVMs) have been developed and introduced in surgical daily practice in the last years to improve preoperative planning and efficacy of selective clamping during nephron sparing surgery. Aim of the study is to evaluate ICG and 3DVMs usefulness in guiding the surgeon's strategy during robot-assisted partial nephrectomy (RAPN).

Materials and methods

We retrospectively reviewed our institutional database and analysed all patients harboring organ-confined renal masses underwent RAPN from 2018 to 2023. Specifically, we included all the patients with a 3DVMs available for preoperative planning and intraoperative surgical navigation. In those cases in which a selective clamping was planned and intraoperatively preformed, ICG solution was injected allowing visualization of the kidney's perfusion regions during the surgery. All demographic, intraoperative, postoperative and functional data were extracted and evaluated, comparing the 3DVM-ICG selective clamping with the global clamping Group.

Results

Overall, 212 patients were included. 111 (51%) patients underwent 3DVM-ICG selective clamping RAPNs. No differences were recorded in terms of preoperative or perioperative variables between the global and the selective clamping group, except for a lower operative time for the global clamping group (93.5 min vs. 100 min, p = 0.02). Focusing on the functional outcomes, the selective clamping group showed better postoperative outcomes in terms of ΔeGFR at every timepoint considered (postoperative: -10.4% vs. -16.7%, p = 0.003; 3rd month: -9% vs. -14%, p = 0.01; 6th month: -8.9% vs. -13.8%, p = 0.04).

Conclusions

ICG and 3DVMs can be considered the most useful and advanced tools to plan an effective selective clamping strategy during RAPN. They can be used in different ways, matching the surgeon's needs from the planning phase to the time of the surgery, leading towards maximum safety and efficacy outcomes.