Comparison of perioperative outcomes of selective arterial clipping guided by near-infrared fluorescence imaging using indocyanine green versus undergoing standard robotic-assisted partial nephrectomy: a systematic review and meta-analysis

Abstract

Background: This study employs a meta-analytic approach to investigate the impact of robotic-assisted partial nephrectomy, with and without near-infrared fluorescence imaging (NIRF-RAPN vs S-RAPN), on patients’ perioperative outcomes and postoperative changes in renal function. Materials and Methods: We conducted a comprehensive and rigorous systematic review and cumulative meta-analysis of primary outcomes following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines, and Risk-of-Bias Tool (RoB2). To ensure a thorough search, we systematically searched five major databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, from databases’ inception to April 2023. Results: No significant differences were found between the two groups in terms of age (P=0.19), right side (P=0.54), BMI (P=0.39), complexity score (P=0.89), tumor size (P = 0.88), operating time (P = 0.39), estimated blood loss (P = 0.47), length of stay (P = 0.87), complications (P = 0.20), transfusion (P = 0.36), and positive margins (P = 0.38). However, it is noteworthy that the NIRF-RAPN group exhibited significant reductions in warm ischemia time (P=0.001), the percentage change in estimated glomerular filtration rate at discharge (P=0.01) compared to the S-RAPN group. Conclusion: This meta-analysis provides evidence that the group undergoing NIRF-RAPN showed a statistically significant protective effect on the estimated glomerular filtration rate (eGFR).