A novel approach to endophytic renal mass: Percutaneous indocyanine green injection for fluorescence-guided robot-assisted renal Tumorectomy

We report a novel fluorescence-guided approach for robot-assisted partial nephrectomy in a completely endophytic renal tumor. A 73-year-old woman with a 3-cm entirely endophytic left renal mass underwent ultrasound-guided percutaneous intratumoral indocyanine green injection after failure of selective arterial embolization. Near-infrared fluorescence imaging allowed accurate intraoperative localization and complete tumor enucleation. Operative time was 125 minutes, with a warm ischemia time of 25 minutes. The postoperative course was uneventful, renal function was preserved, and histopathology confirmed renal oncocytoma. Percutaneous intratumoral indocyanine green injection represents a safe and effective alternative for fluorescence-guided nephron-sparing surgery in anatomically challenging endophytic renal tumors.