PD38-02 UTILIZATION OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY PRIOR TO INTRACORPOREAL URETEROILEAL ANASTOMOSIS FOLLOWING ROBOTIC RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2017PD38-02 UTILIZATION OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY PRIOR TO INTRACORPOREAL URETEROILEAL ANASTOMOSIS FOLLOWING ROBOTIC RADICAL CYSTECTOMY Daniel MO Freitas, Toshitaka Shin, Nariman Ahmadi, Carlos Fay, Andre Luis Abreu, Masakatsu Oishi, Giovanni Cacciamani, Mihir Desai, Inderbir Gill, Andre Berger, and Monish Aron Daniel MO FreitasDaniel MO Freitas More articles by this author , Toshitaka ShinToshitaka Shin More articles by this author , Nariman AhmadiNariman Ahmadi More articles by this author , Carlos FayCarlos Fay More articles by this author , Andre Luis AbreuAndre Luis Abreu More articles by this author , Masakatsu OishiMasakatsu Oishi More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Andre BergerAndre Berger More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1716AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroileal strictures are diagnosed in 2-10% of patients following radical cystectomy and urinary diversion. Poor vascularity of the distal ureteric stumps is a well-known cause factor. Indocyanine-green (ICG) is an exogenous tracer that helps in assessing the vascularity of tissues. Herein, we report a proof-of-concept and our initial experience in using ICG prior performing intracorporeal ureteroileal anastomosis following robotic radical cystectomy (RRC). METHODS From April to November 2016, the use of ICG was analyzed in 10 patients who underwent RRC with intracorporeal urinary diversion (IUD). Intravenous ICG (25mg) was administered prior to ureteroileal anastomosis and the non-enhanced distal ureters were excised prior to ureteric spatulation. Anastomosis was performed in routine manner with 4-0 vicryl sutures over ureteric stents. RESULTS Among 10 patients who underwent to RRC-IUD (5 neobladders and 5 ileal conduits), ICG revealed poor distal ureteric enhancement in 7 patients (70%). Three (30%) patients required bilateral distal ureteral resection, three (20%) patients required left distal ureteral resection and one (10%) patient required right distal ureteral resection. Median resected ureteral length was 2 cm (1-4). Median operative time was 480 minutes (410-620), median EBL was 200 ml (100-650) and median hospital of stay was 5.5 days (3-9). Three patients experienced Clavien 2 complications (fever, n=2 and ileus, n=1). At a median follow-up of 81 days (7-198), no anastomotic strictures were identified. CONCLUSIONS Intravenous injection of ICG prior to ureteroileal anastomosis is a useful tool to evaluate distal ureter vascularity and to identify and excise the transition point of the non-vascularized ureteral segment. Longer follow-up is required to evaluate rates of anastomotic strictures. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e739 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Daniel MO Freitas More articles by this author Toshitaka Shin More articles by this author Nariman Ahmadi More articles by this author Carlos Fay More articles by this author Andre Luis Abreu More articles by this author Masakatsu Oishi More articles by this author Giovanni Cacciamani More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Andre Berger More articles by this author Monish Aron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...