ICG marked Off-C Robotic Partial Nephrectomy for endophytic renal tumors: proof of concept and initial series
INTRODUCTION: We describe a novel technique to mark endophytic renal tumors with transarterial superselective delivery of indocyanine green (ICG)-lipiodol mixture, in patients selected for purely off clamp (OC) robotic partial nephrectomy (RPN).
METHODS: Between September 2017 and October 2017, 10 consecutive patients with predominantly or totally endophytic renal masses underwent superselective transarterial tumor ICG marking and bland embolization immediately before OC-RPN. Preoperative transarterial bland embolization was performed with superselective delivery of lipiodol-indocyanine green mixture (1 to 2 by volume, mixing 1.5 millilitres of indocyanine green with 3 millilitres of lipiodol) into tertiary order arteries feeding the tumor. Purely OC-RPN was performed.
RESULTS: Median PADUA nephrometry score was 10 (IQR 9-11). Median operative time was 75 minutes (IQR 65-85), median estimated blood loss was 250 mL (IQR 200-350). Bland embolization was uneventful in all patients. Hilar clamp was not necessary in any case. Perioperative course was uneventful for all patients and median hospital stay was 3 days (IQR 2-3).Surgical margins were negative in all cases. Eight (80%) patients had renal cell carcinoma histology at final pathology.
CONCLUSIONS:Key benefits of this technique include a quick identification of the mass, avoiding any use of intraoperative ultrasound imaging, and a real time control of resection margins thanks to an improved visualization of tumor.