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    Selective clamping promising in robot-assisted PN

    Technique shows improved post-op renal functional outcomes vs. main artery clamping

    Madrid, Spain—Near-infrared fluorescence-guided selective clamping with indocyanine green (ICG) fluorescent dye in robot-assisted partial nephrectomy (RPN) appears to be a promising technique to delineate renal tumor anatomy for the bloodless resection of renal masses while minimizing ischemic damage to the kidney.

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    In a recent study reported at the European Association of Urology annual congress in Madrid, Spain, patients with renal tumors who underwent RPN combined with selective arterial clamping using ICG showed better postoperative renal functional outcomes than that of a matched pair counterpart that underwent surgery with main artery clamping, according to principal author Nina Harke, MD, assistant medical director and director of scientific research at Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany.

    Applying ICG allows visualization of the disrupted blood flow to the tumor and the renal parenchyma immediately surrounding the tumor, following the selective clamping of the precise tumor-feeding vessels. The technique allows tumor excision in a bloodless field, in an otherwise fully perfused kidney.

    Dr. Harke’s investigation studied the data of 50 patients who underwent RPN using selective arterial clamping with the application of ICG, out of a collective of 250 patients who had undergone RPN since 2009. A matched-pair analysis for estimated glomerular filtration rate (eGFR) and retrospective comparison were carried out for 40 matching partners who underwent main artery clamping.


     

    Baseline renal function levels as matching criteria were nearly the same in both groups, with median eGFR of 88.2 mL/min versus 87.7 mL/min (p=.977) and creatinine of 0.88 vs. 0.83 mg/dL (p=.503) for the global ischemia group and the selective clamping group, respectively.

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    The matched pairs showed no significant differences in mean demographic data for the 40 patients in the global ischemia and selective clamping groups. The median clinical tumor size in global ischemia patients was 30.0 mm versus 33.5 mm in the selective clamping group (p=.170). Accordingly, 74 % of the global ischemia group and 88% of the selective clamping group were allocated to intermediate and high RENAL risk groups (p=.309).

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