Intraoperative dyes, fluorescence and enhanced imaging in benign gynaecologic surgery

Shibata, Renae; Goldman, Theodore; Acholonu, Uchenna C.

doi:10.1097/gco.0000000000000793

Cited by 1 publication

(1 citation statement)

References 47 publications

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“…Recently, robotic or laparoscopic surgery has been preferred due to its cosmetic advantages and rapid recovery; however, it has no or insufficient haptic feedback [ 18 , 19 ]. Therefore, if there is an adjuvant technological imaging system for precise visualization of the retroperitoneal ureter, iatrogenic ureteral damage can be avoided, surgery can become safer and can provide reassurance to surgeons, and even beginners can reduce the learning curve through ureteral navigation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery

Kim,

Jang,

Choi

et al. 2023

JPM

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This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP.

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Section: Discussionmentioning

confidence: 99%