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

Alessandro Veccia; Alessandro Antonelli; Lance J Hampton; Francesco Greco; Sisto Perdonà; Estevão Lima; Ashok K Hemal; Ithaar Derweesh; Francesco Porpiglia; Riccardo Autorino

doi:10.1016/j.euf.2019.03.005

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

Alessandro Veccia, Alessandro Antonelli, Lance J Hampton, Francesco Greco, Sisto Perdonà, Estevão Lima, Ashok K Hemal, Ithaar Derweesh, Francesco Porpiglia, Riccardo Autorino

Istituto Nazionale Tumori Fondazione G. Pascale

Research output: Contribution to journal › Review article › peer-review

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.

Original language	English
Pages (from-to)	505-512
Number of pages	8
Journal	European Urology Focus
Volume	6
Issue number	3
DOIs	https://doi.org/10.1016/j.euf.2019.03.005
Publication status	Published - May 15 2020

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Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy : Pooled Analysis of Comparative Studies. / Veccia, Alessandro; Antonelli, Alessandro; Hampton, Lance J; Greco, Francesco; Perdonà, Sisto; Lima, Estevão; Hemal, Ashok K; Derweesh, Ithaar; Porpiglia, Francesco; Autorino, Riccardo.

In: European Urology Focus, Vol. 6, No. 3, 15.05.2020, p. 505-512.

Research output: Contribution to journal › Review article › peer-review

Veccia, Alessandro ; Antonelli, Alessandro ; Hampton, Lance J ; Greco, Francesco ; Perdonà, Sisto ; Lima, Estevão ; Hemal, Ashok K ; Derweesh, Ithaar ; Porpiglia, Francesco ; Autorino, Riccardo. / Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy : Pooled Analysis of Comparative Studies. In: European Urology Focus. 2020 ; Vol. 6, No. 3. pp. 505-512.

@article{c2dff7ecea75460d8a58da1233be74ed,

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

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.",

author = "Alessandro Veccia and Alessandro Antonelli and Hampton, {Lance J} and Francesco Greco and Sisto Perdon{\`a} and Estev{\~a}o Lima and Hemal, {Ashok K} and Ithaar Derweesh and Francesco Porpiglia and Riccardo Autorino",

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year = "2020",

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doi = "10.1016/j.euf.2019.03.005",

language = "English",

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journal = "European Urology Focus",

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TY - JOUR

T1 - Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy

T2 - Pooled Analysis of Comparative Studies

AU - Veccia, Alessandro

AU - Antonelli, Alessandro

AU - Hampton, Lance J

AU - Greco, Francesco

AU - Perdonà, Sisto

AU - Lima, Estevão

AU - Hemal, Ashok K

AU - Derweesh, Ithaar

AU - Porpiglia, Francesco

AU - Autorino, Riccardo

N1 - Published by Elsevier B.V.

PY - 2020/5/15

Y1 - 2020/5/15

N2 - 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.

AB - 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.

U2 - 10.1016/j.euf.2019.03.005

DO - 10.1016/j.euf.2019.03.005

M3 - Review article

C2 - 30904340

VL - 6

SP - 505

EP - 512

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

IS - 3

ER -