# Details and Updates From the Consensus Meeting on Anatomical Borders for ICG Usage in Urological Laparoscopic and Robotic Kidney Surgery

## TL;DR

This paper summarizes a consensus meeting on using indocyanine green (ICG) in kidney surgeries, highlighting limited current use and mixed evidence of its benefits.

## Contribution

The paper provides updated insights and survey data on ICG usage in urological laparoscopic and robotic kidney surgeries.

## Key findings

- Most observational studies suggest potential benefits of ICG in kidney surgeries, but the only RCT found no significant advantage.
- Only 31% of surveyed urologists use ICG in renal surgeries, with varied dosing and application methods.
- Lack of methodological standardization is a major barrier to wider ICG implementation in these procedures.

## Abstract

This study aimed to update the literature and present findings from a national survey on the current use and perceived utility of indocyanine green (ICG) fluorescence imaging in laparoscopic and robotic kidney surgeries, as discussed at the Consensus Meeting on Anatomy on the Border.

This study consisted of two parts. First, a narrative review of previous studies on ICG application in kidney surgeries was conducted. Second, a questionnaire for urologists certified in laparoscopic surgery was created to evaluate current practices regarding ICG usage.

Nine studies on ICG use in partial nephrectomy were reviewed. The sole randomized controlled trial (RCT) found no significant benefit of ICG‐guided robotic‐assisted partial nephrectomy (RAPN), although the majority of observational studies suggested potential advantages. The lack of methodological standardization remains a major barrier to its wider implementation. Of the 114 urologists contacted, 32 (28%) responded, most of whom had over 20 years of surgical experience. Among the respondents, 31% reported using ICG in renal surgeries: 20% used it exclusively in RAPN, 60% in RAPN in combination with other procedures, and 20% in other surgeries. The dosing varied, but over half of the respondents used 12.5 mg per injection.

Although observational data indicate the potential utility of ICG in renal surgery, the RCT finding is inconclusive, and its current use among urologists remains limited. Nevertheless, ICG holds promise for a broader application in urological procedures.