Cone-Beam CT-Guided Transarterial Tagging of Endophytic Renal Tumors with Indocyanine Green for Robot-Assisted Partial Nephrectomy

Endophytic renal tumors are difficult to identify and dissect during robot-assisted partial nephrectomy (RAPN). The objective of this study is to evaluate the safety, efficacy, and clinical impact of pre-operative selective embolization of endophytic renal tumors with the fluorescent dye indocyanine green (ICG) and lipiodol to allow identification of the endophytic lesions using near infrared fluorescent imaging (NIFI). Materials and Methods Patients with renal endophytic tumors eligible for RAPN and trans-arterial embolization with ICG and lipiodol were prospectively included. Technical success was defined as the completion of the embolization procedure. Iconographic success, defined as the lipiodol accumulation into the nodule, was classified as poor, moderate, good, and excellent based on post-embolization cone-beam CT. Surgical visibility of the tumors during RAPN with the use of NIFI was classified as: not visible, visible with blurred margins, and visible with well-defined margins. Results Forty-two patients underwent pre-operative selective embolization. Technical success was 100%. Lipiodol accumulation at cone beam CT was poor in 2/42 (4,8%), moderate in 6/42 (14,3%), good in 26/42 (61,9%), and excellent in 8/42 patients (19,0%). During RAPN with NIFI, tumors were visible with well-defined margins in 22/42 (52,4%), visible with blurred margins in 15/42 (35,7%) and not visible in 1/42 (2,4%) of cases. There were no adverse events following endovascular embolization. Conclusion Pre-operative trans-arterial super-selective embolization of endophytic renal tumors with ICG and lipiodol in patients undergoing RAPN is safe and effective, allowing accurate intraoperative visualization and resection of endophytic tumors. Conclusion Pre-operative trans-arterial super-selective embolization of endophytic renal tumors with ICG and lipiodol in patients undergoing RAPN is safe and effective, allowing accurate intraoperative visualization and resection of endophytic tumors.