The Role of Indocyanine Green for Robotic Partial Nephrectomy: Early Results, Limitations and Future Directions

The surgical management of small renal masses has continued to evolve, particularly with the advent of the robotic partial nephrectomy (RPN). Recent studies at high volume institutions utilizing near infrared imaging with indocyanine green (ICG) fluorescent dye to delineate renal tumor anatomy has generated interest among robotic surgeons for improving warm ischemia times and positive margin rate for RPN. To date, early studies suggest positive margin rate using ICG is comparable to traditional RPN, however this technology improves visualization of the renal vasculature allowing selective clamping or zero ischemia. The precise combination of fluorescent compound, dose, and optimal tumor anatomy for ICG RPN has yet to be elucidated.