863 NOVEL USE OF INDOCYANINE GREEN FOR INTRAOPERATIVE, REAL-TIME LOCALIZATION OF URETERAL STENOSIS DURING ROBOT-ASSISTED URETEROURETEROSTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013863 NOVEL USE OF INDOCYANINE GREEN FOR INTRAOPERATIVE, REAL-TIME LOCALIZATION OF URETERAL STENOSIS DURING ROBOT-ASSISTED URETEROURETEROSTOMY Ziho Lee, Christopher Reilly, Elton Llukani, David Lee, and Daniel Eun Ziho LeeZiho Lee Philadelphia, PA More articles by this author , Christopher ReillyChristopher Reilly Philadelphia, PA More articles by this author , Elton LlukaniElton Llukani Philadelphia, PA More articles by this author , David LeeDavid Lee Philadelphia, PA More articles by this author , and Daniel EunDaniel Eun Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.431AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Localization of ureteral stenosis during robot-assisted ureteroureterostomy (RAUU) relies largely on visual cues. This may be particularly difficult in the presence of inflammation or fibrosis, which often accompanies the underlying ureteral pathology and obliterates normal dissection planes. Enhancing the ability to visually distinguish healthy versus scarred ureter during RAUU may assist in ureteral dissection and attaining a tension-free anastomosis. Indocyanine green (ICG), a fluorescent dye, is theoretically well suited for this purpose due to its ability to penetrate tissue. ICG has a high signal to noise ratio when viewed under near infrared (NIR) light, a modality available in the da Vinci Si® (Intuitive Surgical, Sunnyvale, CA). We present a novel method to intraoperatively localize ureteral stenosis via ICG injection. METHODS Six patients underwent RAUU for ureteral stricture (2 proximal, 2 middle, and 2 distal) by a single surgeon (DDE) between June and November 2012. Localization of ureteral stenosis was determined by preoperative retrograde pyelography followed by intraoperative instillation of ICG (25 mg in 10 ml distilled water) above and below the level of stenosis through a ureteral catheter or percutaneous nephrostomy tube. Occlusion of the ureteral catheter or nephrostomy tube minimized ICG drainage. Patients were subsequently positioned for robotic ureteral repair in supine lithotomy or flank position depending on the area of ureteral stenosis. The fluorescent tracer was detected as a green color via the NIR modality on the da Vinci Si®. All patients consented to off-label use of ICG after full disclosure. RESULTS Intraoperative ICG injection and visualization under NIR light allowed for definitive identification of healthy ureter which fluoresced green and devitalized ureter which remained un-fluoresced. A spatulated and tension free anastomosis was successful in all 6 RAUU. Mean age of patients was 58 years (range 39-69), mean BMI was 30 kg/m2 (range 22-38), mean operative time was 177 min (range 104-270), and mean EBL was 170 ml (range 50-400). There were no adverse effects attributable to ICG administration. Mean length of stay was 1.7 days (range 1-5), with no postoperative complications. Mean follow up was 1.25 months (range 0.5-3), and all cases were clinically and radiographically successful at the last follow up examination. Follow up in all patients is ongoing. CONCLUSIONS Intraoperative precise localization of ureteral stenosis is safe and feasible through intraureteral ICG injection. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e356 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee Philadelphia, PA More articles by this author Christopher Reilly Philadelphia, PA More articles by this author Elton Llukani Philadelphia, PA More articles by this author David Lee Philadelphia, PA More articles by this author Daniel Eun Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...