Matthew J Pergamo, MD, Michael A Granieri, MD, Aaron Weinberg, MD, Lee Zhao, MD, Mitchell Bernstein, MD, Alexis Grucela, MD. NYU School of Medicine
Introduction: Ureteral injury during colon resection (reported range 0.28-7.6%.) can have devastating consequences for patients including increased morbidity, mortality, and cost. Ureteral stenting is commonly used to aid in ureteral identification and recognize intraoperative injury, especially in patients with diverticulitis, Crohn’s Disease, reoperative pelvic surgery, or with history of radiation therapy. In patient’s undergoing laparoscopic or robotic surgery, lighted stents have been used; however, at a higher cost. We report a novel technique for ureteral visualization by injecting standard ureteral catheters with indocyanine green (ICG) during robotic colon resection. We aim to show the benefits including low cost, excellent intraoperative visualization of the ureters, and low morbidity.
Methods and Procedures: An IRB approved review of our prospectively maintained database was conducted of all robotic colon resections performed at our institution. In select cases, cystoscopy with open ended ureteral catheter placement and ICG injection were performed by three experienced urologists. Once placed, 5cc of ICG was injected into the stent, which were then connected to a separate drainage bag. Surgeons were then able to identify the ureter and stent via firefly mode on the Da Vinci Xi® platform. Inclusion criteria were ureteral stent placement (Unilateral, Bilateral), ICG injection and colon resection. Surgeries were performed between 4/2017-8/2018. Data gathered included demographics, type and indication of resection, intraoperative and postoperative complications, and readmissions.
Results: 30 patients were identified who underwent robotic colon resection with ICG ureteral stent placement. The most common procedure performed was low anterior resection 40%(12/30) and the most common indication for surgery was diverticulitis 46.7%(14/30). There were no ureteral injuries 0%(0/30) and no major morbidities or mortalities (0%). The ureters were identified using firefly mode in 100%(30/30) of patients (Image A/B). Most patients underwent bilateral stent placement 66%(20/30), with remainder being unilateral. There was 1(3.3%) minor postoperative urologic complication, AKI from under-resuscitation, resolved with hydration. There were no (0%)urinary tract infections. There were no 30-day readmissions. One(3.3%) patient was seen in the emergency room within 30-days for a port site hernia not requiring operation. At our institution, lighted stents cost approximately $1500/stent, while standard stents are $100/stent and ICG $508 /vial resulting in $254/injection.
Conclusion: The use of ICG injected ureteral stents is a novel technique for intraoperative ureteral identification that is safe, effective, with time and cost saving benefits. This technique should be studied further in prospective randomized controlled trials to further quantify time and cost benefit.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94554
Program Number: P689
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster