Daniel R Slack, MD, Sandeep Sachidananda, MD, Diego Holguin, MD, Jayakara Shetty, MD. Waterbury Hospital
Background: Identification and preservation of ureter is a technical challenge during colon and pelvic surgery. The use of fluorescent dye has recently been included as an adjunct to enable easy intra-operative identification and hence preservation of the ureter during robotic-assisted surgery.
Aim: We want to study the feasibility and utility of Firefly Fluorescence Endoscope system during robotic-assisted colon resections.
Methods: We retrospectively reviewed cases in which Firefly technology was used by our surgeons in the time period Jan 2016 to April 2017. Our technique included a urologist to perform an on-table cystogram with the placement of bilateral ureteric stents and instillation of 5 cc of ICG( Indocyanine green) to each ureteric orifice under direct vision. The stents were left in place during the procedure and removed at the end of the procedure. While the robot removes tactile sensation it allows for the use of near-infrared laser that helps the ICG fluoresce as well as lens filtering, called Firefly Fluorescence Endoscope system which converts the fluorescing ICG to a bright green color. The operation was performed and Firefly mode was used as required throughout the case to visualize the ureter at the surgeon’s discretion by flip of a switch on the surgeons console.
Results: In our institution we identified 10 cases in which using ICG and Firefly Fluorescence was used. We observed 100 % success rate in identifying and preserving ureters. The cases mainly included sigmoid resections especially in the setting of recurrent/complicated diverticulitis. No ureteric injuries were noted in this series.
Conclusion: The use of ICG and robotic Firefly Fluorescence technology enables easy identification of ureter during colon resections. Our early experience with this novel technique has shown that this is both easy to perform and effective in allowing visualization of the ureters especially in difficult cases where the risk of ureteral injury can be high. No side effects are noted by the use of ICG. This technology has the potential to decrease the rate of intra-operative ureteral injury in complicated colon resections and also in pelvic gynecological procedures as well. Future comparative studies should be performed to better assess whether there is true reduction in ureteric injury identification and/or prevention.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91169
Program Number: ET013
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium
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