Intraoperative ICG-fluorescence imaging of ureteral defect: case report and literature review

Abstract

Iatrogenic ureteral injury is the most frequent trauma during pelvic surgery. Due to the peculiarities of this topographic region, assessment of ureteral wall perfusion is critical for prevention of ischemic complications.In modern surgical practice, assessing local ureteral perfusion is often based on the surgeon’s subjective opinion. Intraoperative angiography with indocyanine green (indocyanine green, ICG) has been shown to be an adequate reflection of tissue perfusion and potentially influence the outcome of surgery.Currently, there are insufficient data regarding the use of ICG in iatrogenic ureteral injury. In this article, we describe a successful ICG fluorescence-guided middle third ureteroplasty in a 92-year-old patient with uterine cancer who underwent a simple hysterectomy. We also review the literature on this topic. The literature search for the review was performed using the PubMed database.Based on currently available data, the use of ICG for defect detection and control during ureteral resection is feasible and safe. However, the significance of this procedure should be evaluated in further studies.