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Journal of Robotic Surgery

, Volume 13, Issue 3, pp 391–396 | Cite as

Fluorescence-guided selective arterial clamping during RAPN provides better early functional outcomes based on renal scan compared to standard clamping

  • Daniele MatteviEmail author
  • L. G. Luciani
  • W. Mantovani
  • T. Cai
  • S. Chiodini
  • V. Vattovani
  • M. Puglisi
  • G. Malossini
Original Article

Abstract

To compare the functional and operative outcomes of robot-assisted partial nephrectomy with selective arterial clamping guided by near infrared fluorescence imaging (NIRF-RAPN) versus a cohort of patients who underwent standard RAPN without selective arterial clamping (S-RAPN). 62 consecutive patients underwent RAPN from January 2016 to May 2017: the last 20 patients underwent NIRF-RAPN. Preoperative and postoperative renal scan at 1 month were performed to evaluate the glomerular filtration rate (GFR) of the operated renal unit and total function. Functional and operative outcomes of cases were compared with a cohort of 42 patients undergoing S-RAPN. Selective clamping was performed in 15 patients (75%), whereas five (25%) cases were converted to S-RAPN, due to incomplete ischemic appearance of the tumor after selective clamping. Median tumor diameter was 40 mm in both groups. Median selective clamping was 24 min in both groups. Operative time (206’ vs 190’) and blood loss (200 vs 170 cc) were comparable. No major complications have been reported in the NIRF-RAPN group, whereas three acute hemorrhages with embolization were found in the S-RAPN group. The analysis of renal scan data revealed that a greater loss of GFR in the operated renal unit was observed after S-RAPN compared to NIRF-RAPN [21.5% vs. 5.5%; p = 0.046], as well as total GFR loss [8% vs 0%; p = 0.007]. The use of NIRF imaging was associated with improved short-term renal functional outcomes compared to RAPN without selective arterial clamping. To our knowledge, this is the first comparative study analyzing the GFR obtained from renal scan.

Keywords

Near infrared fluorescence Robotic Partial nephrectomy Renal ischemia Renal scan 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Daniele Mattevi
    • 1
    Email author
  • L. G. Luciani
    • 1
  • W. Mantovani
    • 2
  • T. Cai
    • 1
  • S. Chiodini
    • 1
  • V. Vattovani
    • 1
  • M. Puglisi
    • 1
  • G. Malossini
    • 1
  1. 1.Department of UrologySanta Chiara HospitalTrentoItaly
  2. 2.Department of PreventionPublic Health Care Trust TrentoTrentoItaly

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