Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy?

Tyler R. McClintock, Marc A. Bjurlin, James S. Wysock, Michael S. Borofsky, Tracy P. Marien, Chinonyerem Okoro, Michael D. Stifelman

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Abstract

Objective 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. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (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/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective 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 technology.

Original languageEnglish (US)
Pages (from-to)327-334
Number of pages8
JournalUrology
Volume84
Issue number2
DOIs
StatePublished - Jan 1 2014

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Optical Imaging
Robotics
Nephrectomy
Glomerular Filtration Rate
Constriction
Kidney
Matched-Pair Analysis
Body Mass Index
Fluorescence
Prospective Studies
Technology
Neoplasms

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Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? / McClintock, Tyler R.; Bjurlin, Marc A.; Wysock, James S.; Borofsky, Michael S.; Marien, Tracy P.; Okoro, Chinonyerem; Stifelman, Michael D.

In: Urology, Vol. 84, No. 2, 01.01.2014, p. 327-334.

Research output: Contribution to journalArticle

McClintock, Tyler R. ; Bjurlin, Marc A. ; Wysock, James S. ; Borofsky, Michael S. ; Marien, Tracy P. ; Okoro, Chinonyerem ; Stifelman, Michael D. / Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy?. In: Urology. 2014 ; Vol. 84, No. 2. pp. 327-334.
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title = "Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy?",
abstract = "Objective 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. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (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/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9{\%} vs -16.8{\%}; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective 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 technology.",
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AU - Marien, Tracy P.

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N2 - Objective 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. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (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/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective 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 technology.

AB - Objective 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. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (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/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective 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 technology.

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