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 m(2); P = .04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m(2); 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: McClintock
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bjurlin
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: James S
authors.initials: JS
authors.lastname: Wysock
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borofsky
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: Tracy P
authors.initials: TP
authors.lastname: Marien
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY.
authors.forename: Chinonyerem
authors.initials: C
authors.lastname: Okoro
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY. Electronic address: michael.stifelman@nyumc.org.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061848:Optical Imaging; D011446:Prospective Studies; D012077:Renal Artery; D012371:Robotics; D055815:Young Adult