Department of Urology, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Department of Urology, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Eur Urol. 2020 Nov;78(5):743-749. doi: 10.1016/j.eururo.2020.05.040. Epub 2020 Jun 15.
In recent years, novel technologies have been implemented in order to improve the surgical outcomes of robot-assisted partial nephrectomy (RAPN). Intraoperative administration of indocyanine green (ICG) has been proposed to assess kidney perfusion intraoperatively.
To confirm, on a large scale, the effectiveness of near-infrared fluorescence ICG-guided RAPN in leading the surgeon strategy and to provide hints to the use of this tool.
DESIGN, SETTING, AND PARTICIPANTS: The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group collected data from 737 patients subjected to RAPN between 2010 and 2016 at three tertiary care referral centers. Of them, 318 had complete demographic and clinical data, and underwent ICG-guided RAPN for clinically localized kidney cancer.
Patients were subjected to RAPN with intraoperative intravenous ICG injection.
Optimal surgical outcomes, defined according to both the margin, ischemia, and complication (MIC), and the trifecta score, were assessed.
A total of 194 (61%) patients were male and 124 (39%) were female. The median patient age was 61 yr and median preoperative tumor size was 30 mm. Median operative time, estimated blood loss, and warm ischemia time were, respectively, 162 min, 100 ml, and 17 min. In total, 228 (71.7%) and 254 (79.9%) individuals, respectively, were selected as optimal surgical patients defined according to MIC and trifecta. The univariate and multivariable logistic regression models showed that tumor complexity nephrometry scores were independent predictors of both trifecta and MIC. The main limitation of this study is the lack of a control group.
We report the largest population of patients who underwent ICG-guided RAPN. Intraprocedural ICG administration represents a useful tool where the vascular anatomy is challenging, and it could be implemented to maximize the adoption of RAPN.
We demonstrated that indocyanine green (ICG) is a reliable tool for guiding the surgeon strategy during robot-assisted partial nephrectomy. ICG may help in procedure tailoring, especially in cases with challenging vascularization or impaired renal function.
近年来，为了提高机器人辅助部分肾切除术（RAPN）的手术效果，已经采用了一些新技术。术中应用吲哚菁绿（ICG）已被提议用于术中评估肾脏灌注。
在大规模范围内证实近红外荧光吲哚菁绿指导 RAPN 引导外科医生策略的有效性，并为该工具的使用提供线索。
设计、地点和参与者：跨大西洋机器人保肾手术（TRoNeS）研究小组收集了 2010 年至 2016 年间在三个三级转诊中心接受 RAPN 的 737 例患者的数据。其中，318 例患者有完整的人口统计学和临床数据，并接受了 ICG 引导的 RAPN 治疗临床局限性肾癌。
患者接受 RAPN 手术，术中静脉注射 ICG。
根据切缘、缺血和并发症（MIC）和三联征评分评估最佳手术效果。
共有 194 例（61%）患者为男性，124 例（39%）为女性。患者中位年龄为 61 岁，中位术前肿瘤大小为 30mm。中位手术时间、估计失血量和热缺血时间分别为 162 分钟、100 毫升和 17 分钟。分别有 228 例（71.7%）和 254 例（79.9%）患者根据 MIC 和三联征被选为最佳手术患者。单变量和多变量逻辑回归模型显示，肿瘤复杂性肾切除术评分是三联征和 MIC 的独立预测因子。本研究的主要局限性是缺乏对照组。
我们报告了接受 ICG 引导 RAPN 的最大患者人群。术中 ICG 给药是一种有用的工具，适用于血管解剖结构具有挑战性的情况，它可以被用来最大限度地推广 RAPN 的应用。
我们证明吲哚菁绿（ICG）是指导机器人辅助部分肾切除术外科医生策略的可靠工具。ICG 可能有助于手术定制，特别是在血管化具有挑战性或肾功能受损的情况下。
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