Objectives To compare renal functional outcomes in robotic partial nephrectomy (RPN)

Objectives To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. eGFR functional kidney status age sex body mass index and American Society of Anesthesiologists score who underwent RPN without selective clamping and NIRF imaging. Results In matched-pair analysis selective clamping with NIRF was associated with superior kidney function at discharge as demonstrated by postoperative eGFR (78.2 vs 68.5 ml/min GSK 0660 per 1.73m2; P=0.04) absolute reduction of eGFR (?2.5 vs ?14.0 ml/min per 1.73m2; P<0.01) and percent change in eGFR (?1.9% vs ?16.8% P<0.01). Similar trends were noted at three month follow up but these differences became non-significant (P[eGFR]=0.07] P[absolute reduction of eGFR]=0.10 and P[percent change in eGFR]=0.07). In the selective clamping group a total of four perioperative complications GSK 0660 occurred in three patients all of which were Clavien I-III. Conclusion Utilization of NIRF imaging was associated with improved short-term renal functional outcomes when compared to RPN without selective GSK 0660 arterial clamping and NIRF imaging. With this effect attenuated at later follow-up randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this Rabbit Polyclonal to DNL3. technology. Keywords: Carcinoma renal cell fluorescence indocyanine green kidney incomplete nephrectomy robotic Launch Incomplete nephrectomy (PN) is among the most regular of look after most little renal tumors 1 attaining oncologic effectiveness much like radical nephrectomy along with minimal occurrence of chronic kidney disease 2 cardiovascular occasions and mortality.3 4 Since its preliminary description in 2004 robotic partial nephrectomy (RPN) has obtained acceptance being a PN technique that possesses lots of the minimally invasive great things about a laparoscopic approach though using a learning curve that’s not nearly as steep.5 Research show RPN to become ideal for T1a renal public as well regarding more technical cases including tumors close to the hilum or higher than four centimeters in size.6 7 Using the functional great things about RPN largely a byproduct from the functional tissues that continues to be following tumor resection focus has considered allowing the surgeon to excise or harm only a small amount normal renal tissues as it can be while still performing an oncologically complete method. It has prompted the introduction of selective renal ischemia in RPN in a way that primary artery clamping which problems healthy tissues through global ischemia and reperfusion damage 8 is no more necessary.9 An innovative way of intraoperative functional imaging near infrared fluorescence (NIRF) may further improve segmental arterial clamping techniques by aiding GSK 0660 in identification of renal vasculature and assessment of associated renal perfusion and ischemia. NIRF imaging consists of intravenous administration of the fluorescent comparison agent which emits light in the near infrared wavelength after activation with a led. Light within this wavelength (700-850nm) isn’t noticeable to the nude eye and should be captured with a specific charge-coupled gadget (CCD) camera to GSK 0660 become visualized. Using the most broadly examined fluorescent tracer to time indocyanine green (ICG) (Akorn Lake Forest IL) NIRF imaging could be built-into the da Vinci Si Operative System (Intuitive Operative Sunnyvale CA) and enables the physician to toggle between regular white light and fluorescence-enhanced sights instantly inside the preexisting gaming console display. We’ve previously defined our technique of NIRF-enhanced selective clamping in RPN and reported preliminary outcomes within a multi-institutional research.10 11 Here we present a matched-pair analysis of associated postoperative renal function at both discharge and three-month follow-up in 42 individuals at our own institution compared with a cohort who underwent RPN with conventional main artery clamping during a similar time period. MATERIALS AND METHODS Our prospectively managed institutional review board-approved database was queried to identify consecutive individuals who underwent RPN with selective.