Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy: Pooled Analysis of Comparative Studies

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 NIRFRAPN 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]: 9.26 ml/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: 7.91 ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower Delta % 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.