{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:50:12Z","timestamp":1787583012348,"version":"build-2736575974"},"reference-count":43,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Partial nephrectomy is the standard treatment for small renal tumors, balancing cancer control with renal function preservation. Robot-assisted partial nephrectomy (RAPN) has improved surgical precision and reduced morbidity. Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) improves intraoperative visualization of renal vasculature and tissue perfusion, potentially enabling selective arterial clamping to reduce ischemic injury. This study updates contemporary evidence on NIRF\/ICG-guided RAPN, focusing on intraoperative, perioperative, and renal function outcomes. Materials and Methods: We systematically queried PubMed, Scopus, and Web of Science databases up to June 2025 for controlled prospective and retrospective studies comparing NIRF\/ICG-guided RAPN (selective clamping or zero-ischemia) versus conventional RAPN with main artery clamping in adults with renal masses. Data were synthesized narratively, and random-effects meta-analyses were performed on warm ischemia time (WIT), operative time, estimated blood loss, transfusion rate, length of hospital stay, complication rate, positive surgical margins, and variation in renal function. Results: Eleven studies (10 full-text and one abstract), including two randomized controlled trials, encompassing a patient population of 893 patients (403 NIRF\/ICG-guided RAPN and 490 conventional RAPN), were included. Ischemia strategies varied between no clamping, selective or super-selective clamping for NIRF\/ICG, and main artery clamping for controls. ICG doses ranging from 3 to 7.5 mg or 0.5\u20137 mL. Most evidence was classified as level 2b or 3b, indicating a moderate to serious risk of bias. Meta-analysis showed that compared to conventional RAPN, NIRF\/ICG-guided RAPN was associated with a shorter WIT (MD: \u22121.30 min, 95% CI: \u22122.51 to \u22120.09; p = 0.039), with no differences in other outcomes. Renal function favored NIRF\/ICG at discharge and short-term follow-up, although the difference was not statistically significant. Conclusions: NIRF\/ICG reduces WIT during RAPN without increasing perioperative risks. The technique shows promise for better preserving functional outcomes. However, further well-designed, large-scale trials with longer follow-up are needed to confirm these benefits and define clinical indications.<\/jats:p>","DOI":"10.3390\/medicina61101735","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T12:15:31Z","timestamp":1758716131000},"page":"1735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Role of Near-Infrared Fluorescence with Indocyanine Green in Robot-Assisted Partial Nephrectomy: Results from an Updated Systematic Review and Meta-Analyses of Controlled Studies"],"prefix":"10.3390","volume":"61","author":[{"given":"Andrea","family":"Panunzio","sequence":"first","affiliation":[{"name":"Dott. Alessandro Tafuri Medical Center, 73100 Lecce, Italy"},{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Orlando","sequence":"additional","affiliation":[{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-0238","authenticated-orcid":false,"given":"Federico","family":"Greco","sequence":"additional","affiliation":[{"name":"Ultrasound Radiogenomics AI Center, 70726 San Pancrazio Salentino, Italy"},{"name":"Department of Radiology, Cittadella della Salute, Azienda Sanitaria Locale di Lecce, 73100 Lecce, Italy"},{"name":"Research Unit of Radiology, Department of Medicine and Surgery, Universit\u00e0 Campus Biomedico di Roma, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Cerrato","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena Domenica","family":"D\u2019Elia","sequence":"additional","affiliation":[{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Marinaci","sequence":"additional","affiliation":[{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Manno","sequence":"additional","affiliation":[{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliasger","family":"Shakir","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Department of Urology, Mater Dei Hospital, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Baccaglini","sequence":"additional","affiliation":[{"name":"Urology Department, Centro Universitario FMABC, Santo Andr\u00e8 09060-870, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Benito","family":"Porcaro","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9167-2587","authenticated-orcid":false,"given":"Andre","family":"Abreu","sequence":"additional","affiliation":[{"name":"USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Tafuri","sequence":"additional","affiliation":[{"name":"Dott. Alessandro Tafuri Medical Center, 73100 Lecce, Italy"},{"name":"Department of Urology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.eururo.2025.02.020","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update","volume":"87","author":"Bex","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e20250203","DOI":"10.1590\/s1677-5538.ibju.2025.0203","article-title":"Management of Small Renal Masses: Literature and Guidelines Review","volume":"51","author":"Silvestri","year":"2025","journal-title":"Int. Braz. J. 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