Sheev I Dattani, MD, Haane G Massarotti, MD, Allen P Chudzinski, MD. Florida Hospital Tampa
INTRODUCTION: The purpose of our report is to highlight the use of intraureteral indocyanine green (ICG) and subsequent visualization using near-infrared fluorescence (NIRF) to prevent iatrogenic ureteral injuries. Robotic surgery has gained popularity over the years specifically in colorectal surgery. Ureteric Injury remains a feared complication for the Colorectal Surgeon ranging in the literature from <1 to 8 percent and leads to significant morbidity to the patient.
Prevention of injury has been a primary focus and several methods have been described, such as intraoperative identification with the use cystoscopy, placement of ureteric stents, lighted ureteral stents, and the use of methylene blue have been described. The use of Indocyanine Green in colorectal surgery for ureteric identification has yet to be studied in the literature.
METHODS AND PROCEDURES: This is a retrospective analysis of 14 patients who underwent elective colorectal resection for both benign and malignant disease at Florida Hospital Tampa, Florida, USA during the dates of 01/01/2017-11/09/2017. Our database included all patients undergoing placement of ureteric stents patients were excluded if they did not undergo ICG placement. Patients underwent cystoscopy then had a lighted 6F ureteral stent (Stryker)placed on one side. A 5F pollack (Cook) stent was then temporarily placed in the opposite ureter followed by injection of 5cc of ICG. Alternatively in some patients, both ureters were injected with 5cc ICG via a 5F pollack stent. The pollack stents were then removed. Cases included colectomies and low anterior resections. The da Vinci Xi Surgical System was used to complete our case in the usual fashion. Data analysis was then presented as mean.
RESULTS: Our study included 14 patients 7 male, 7 female. Our averages included age 55, BMI 29.1 operative time 331 minutes, EBL 103 ml. There were no iatrogenic injuries to the ureter or intraoperative complications on these 14 procedures, no anesthetic complications were noted. Two patients had urinary retention, one patient required a blood transfusion postoperatively.
CONCLUSION: Due to its simplicity and effectiveness in early ureteral identification, we suggested that this technique may be potentially valuable during colorectal procedures for ureteral avoidance when there is a risk for unintended ureteral injury. Of note, during our first use of this technique during routine placement of lighted stents the urologist was unable to place the right ureteric stent, in this case ICG was instilled without complication and the ureter immediately visualized. This novel technique will be beneficial to others in a similar situation.
Likely this will also lead to a substantial time and cost savings and thus less burden on the healthcare system.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91142
Program Number: ETP883
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster