Category: Laparoscopic/ Robotic: Renal

VS17-9 - ICG marked Off-Clamp Robotic Partial Nephrectomy for endophytic renal tumors: proof of concept and initial series

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Partial nephrectomy for endophytic renal tumors is a challenging surgical procedure. The use of intraoperative ultrasound allows the surgeon to localize the tumor and to score the resection margins, but does not provide any information about resection margins in the deep part of resection. We describe a novel technique to mark endophytic renal tumors with transarterial superselective delivery of indocyanine green (ICG)-lipiodol mixture, in patients selected for purely off clamp (OC) robotic partial nephrectomy (RPN).


Methods :

Between September 2017 and October 2017, 10 consecutive patients with predominantly or totally endophytic renal masses underwent
superselective transarterial tumor ICG marking and bland embolization immediately before OC-RPN. Preoperative transarterial bland embolization was performed with superselective delivery of lipiodol-indocyanine green mixture (1 to 2 by volume, mixing 1.5 millilitres of indocyanine green with 3 millilitres of lipiodol) into tertiary order arteries feeding the tumor. Purely OC-RPN was performed. Near infrared fluorescence imaging was used to early identify the tumor, to score resection margins and to obtain an image guided control of resection margins. Baseline, clinical, perioperative and pathologic data were reported.


Results :

Median tumor size was 3 cm (IQR 2.3-3.8). Median PADUA nephrometry score was 10 (IQR 9-11). Median operative time was 75 minutes
(IQR 65-85), median estimated blood loss was 250 mL (IQR 200-350). Bland embolization was uneventful in all patients. Hilar clamp was not necessary in any case, as well as no conversion to radical nephectomy was needed. Perioperative course was uneventful for all patients and median hospital stay was 3 days (IQR 2-3). At discharge, median Hgb and percent eGFR drop down were -3.3 g/dL (IQR 2.1-3.3) and -11% (IQR 10-20), respectively. Surgical margins were negative in all cases. Eight (80%) patients had renal cell carcinoma histology at final pathology.


Conclusions :

We describe a novel technique to simplify challenging RPNs based on ICG-lipiodol tumor marking with preoperative superselective
bland embolization. Key benefits of this technique include a quick identification of the mass, avoiding any use of intraoperative ultrasound imaging, and a real time control of resection margins thanks to an improved visualization of tumor.

Giuseppe Simone

Consultant
“Regina Elena” National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Leonardo Misuraca

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Gabriele Tuderti

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Mariaconsiglia Ferriero

MD, PhD
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Francesco Minisola

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Giulio Vallati

"Regina Elena" National Cancer Institute, Dept. of Radiology
Roma, Lazio, Italy

Giuseppe Pizzi

"Regina Elena" National Cancer Institute, Dept.of Radiology
Roma, Lazio, Italy

Salvatore Guaglianone

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Michele Gallucci

Roma, Lazio, Italy