Fluorescence in Partial Nephrectomy

According to international guidelines partial nephrectomy can be performed based on the surgeon’s expertise and skills. With increasing experience and knowledge even the most challenging tumor constellations are nowadays in the focus of robot-assisted surgery. Since the first laparoscopic radical nephrectomy in 1991, the minimally invasive approach has become highly approved in renal surgery. However, in addition to the steep learning curve, one major point of criticism in laparoscopic partial nephrectomy is the prolonged warm ischemia time. Hence, several techniques like early unclamping of the renal hilum were established to reduce ischemic injury to the kidney. Due to enhanced instruments and improved vision, robotic surgery has an impact on reducing warm ischemia time. However, those above-mentioned laparoscopic techniques continued to require disruption of the entire arterial blood flow during tumor resection. An additional point of criticism is the missing haptic feedback. While tumor identification in more endophytic renal tumors can also be demanding in open surgery, the lack of a tactile senor system in laparoscopy and robotic surgery may lead to an even more challenging definition of the exact tumor boundaries. Near-infrared fluorescence with indocyanine green is one tool to overcome these obstacles in robotic renal surgery.