Indocyanine green fluorescence imaging for laparoscopic complex upper urinary tract reconstructions: a comparative study

Abstract

Background: To describe our technique for using an intraureteral injection of indocyanine green (ICG) and visualization under near-infrared fluorescence (NIRF) to facilitate challenging upper urinary tract reconstructions (UUTRs) and to present the comparative outcomes.Methods: We collected 36 patients who underwent laparoscopic UUTRs between April 2019 and March 2020, and we divided the patients into two groups based on the use of ICG (ICG group and non-ICG group). Demographic characteristics, perioperative outcomes, and functional outcomes were compared between the two groups.Results: There were 18 cases in the ICG group and 18 cases in the non-ICG group, respectively. There were no differences in the baseline characteristics between the two groups. The intraoperative time to identification of the ureter (TIU; 20.9±11.7 vs. 30.0±14.6 min, P=0.03) and length of postoperative hospital stay (LPHS; 11.1±3.0 vs. 16.6±10.0 days, P=0.03) were significantly shorter in the ICG group. There was also a trend for lesser time for locating the stricture (43.0±27.9 vs. 55.4±18.6 min, P=0.14) and lower estimated blood loss (EBL) in the ICG group patients (88.3±75.4 vs. 91.7±46.2 mL, P=0.22). During the mean 3.8-month follow-up for the ICG group and the 6.2-month for the non-ICG group, there was a trend for more severe complications in the non-ICG group.Conclusions: Visualizing intraureteral ICG under NIRF is useful in challenging UUTRs, allows for rapid ureteral identification and accurate real-time delineation of the ureteral stricture margins, and provides encouraging follow-up outcomes compared with those in the non-ICG group.

Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept

“…The concept of IDS can be applied widely in endourology across various instruments: for example, all fluoroscopy operations involve the injection of contrast medium with dead space shifts. Going beyond ureteroscopes, IDS can be applied to the majority of instruments routinely used for injection or aspiration in urology, including cystoscopes, ureteral catheters, 37 , 38 nephroscopes, and nephrostomy tubes. 39 , 40 A greater impact would likely be in instruments used in the upper urinary tract, due to the smaller volume of the pyelocaliceal system compared to the bladder.…”

Intraoperative ICG-Fluorescence Imaging of Lymph Nodes in Robot-Assisted Radical Cystectomy in Patients with Bladder Cancer

“…Появление технологии FireFly® (Intuitive Surgical, Саннивейл, Калифорния, США) в 2011 году позволило использовать ICG совместно с роботизированной хирургической системой Da Vinci®, благодаря чему расширилось применение ICG в урологии. Стали возможны ICGфлуоресцентные робот-ассистированные операции, среди которых резекция почки [14], реимплантация мочеточника, реконструкция лоханочно-мочеточникового сегмента, уретеролизис и уретеро-уретеростомия [15]. Также непосредственное инъецирование ICG в почечную лоханку и мочеточник позволило облегчить интраоперационную идентификацию мочеточника во время уретеро-уретеростомии, уретеролизиса и пиелопластики [15][16][17].…”

“…Стали возможны ICGфлуоресцентные робот-ассистированные операции, среди которых резекция почки [14], реимплантация мочеточника, реконструкция лоханочно-мочеточникового сегмента, уретеролизис и уретеро-уретеростомия [15]. Также непосредственное инъецирование ICG в почечную лоханку и мочеточник позволило облегчить интраоперационную идентификацию мочеточника во время уретеро-уретеростомии, уретеролизиса и пиелопластики [15][16][17]. Одним из направлений для применения данного метода является картирование СЛУ при солидных опухолях мочевыделительной системы [18][19][20].…”