Pioneering the retroperitoneal approach: Indocyanine green fluorescence-guided embolization in totally endophytic renal masses during robot-assisted partial nephrectomy

Abstract

Purpose: This study aimed to evaluate the feasibility and outcomes of utilizing superselective transarterial indocyanine green (ICG)-lipiodol delivery to arterial branches supplying renal masses. Retroperitoneal robot-assisted partial nephrectomy (RAPN) was performed on 8 patients, and the characteristics of the patients, operative outcomes, and renal function results were assessed. Materials and methods: A preoperative procedure involved the transarterial delivery of an ICG-lipiodol mixture into tertiary-order arterial branches supplying renal masses. Retroperitoneal RAPN was performed on 8 patients, with detailed assessments of patient characteristics, operative outcomes, and renal function results. Results: The tumors were predominantly on the left side (mean size, 2.5 cm; RENAL nephrometry score, 7.3). The operative outcomes were favorable, with minimal ischemia time, no complications, and 100% margin-free resections. Individual renal functions showed a mild decrease in the estimated glomerular filtration rate, emphasizing the safety of ICG. Conclusion: The findings of this study support the effectiveness of retroperitoneal RAPN for challenging endophytic renal masses and introduce a novel approach with superselective transarterial ICG-lipiodol delivery, demonstrating favorable operative outcomes and successful preservation of renal function.