Intraoperative Doppler Verification of Arterial Occlusion in Minimally Invasive Renal Resection

Introduction: Color Doppler mapping (DUSG) enables evaluation of parenchymal perfusion after clamping the renal artery. The aim of this study was to evaluate DUSG and compare its outcomes with ICG fluorescence imaging and with a control group without intraoperative imaging. Methods: We retrospectively analyzed 426 patients operated on at our institution between 2018 and July 2025. Ischemia was verified using DUSG (n = 174; 41%) and ICG (n = 29; 7%). A choice of method was non-systematic based on surgeon decision only. The control group included 223 patients (52%). Demographic, oncological and surgical parameters, selective clamping, clamp adjustments, and positive resection margins (pR1) were evaluated. ANOVA/Kruskal–Wallis and chi-square tests were used for comparison. Results: No significant differences were found between groups in tumor size, BMI, blood loss or WIT. Selective clamping was more frequent with DUSG and ICG compared in controls (p < 0.001). Clamp adjustment was required in 24% of DUSG, 62% of ICG, and 3% of control cases (p < 0.001). The rate of pR1 was low across groups. Conclusion: Intraoperative perfusion verification is advantageous when ischemia is not clearly visible. Both DUSG and ICG are safe and reliable. DUSG represents an effective, accessible and economical alternative suitable for broader clinical use.