The use of indocyanine green during robotic ureteroenteric reimplantation for the management of benign anastomotic strictures

Ziho Lee*, Matthew E. Sterling, Aryeh Y. Keehn, Matthew Lee, Michael J. Metro, Daniel D. Eun

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Purpose: We describe our technique for using intraureteral and intraurinary diversion indocyanine green (ICG) during robotic ureteroenteric reimplantation and report our outcomes. Methods: We retrospectively reviewed eight patients who underwent ten robotic ureteroenteric reimplantations between August 2013 and July 2017. ICG was injected antegrade and/or retrograde into the lumen of the ureter, and retrograde into the lumen of the urinary diversion. All patients consented to off-label use of ICG. Postoperatively, all patients were assessed for: clinical success: the absence of flank pain; and radiological success: the absence of obstruction on renal scan and/or loopogram. Results: Visualization of ICG under near-infrared fluorescence allowed for precise identification of the strictured ureter and urinary diversion, which fluoresced green; and localization the ureteroenteric stricture margins, which poorly fluoresced green. The median operative time was 208 min (IQR 191–299), estimated blood loss was 125 ml (IQR 69–150), and length of stay was 6 days (IQR 1–8). Three of eight (37.5%) patients suffered a minor (Clavien ≤ 2), and 2/8 (25.0%) patients suffered a major (Clavien > 2) post-operative complication. There were no complications related to ICG use. At a median follow-up of 29 months (IQR 21–38), 8/10 (80.0%) ureteroenteric reimplantations were clinically and radiologically successful. Conclusions: Intraureteral and intraurinary diversion ICG may be utilized as a real-time contrast agent during robotic ureteroenteric reimplantation to assist with identification of the strictured ureter and urinary diversion, and delineation of the ureteroenteric stricture margins. Despite this, RUER remains a technically difficult and morbid procedure.

Original languageEnglish (US)
Pages (from-to)1211-1216
Number of pages6
JournalWorld journal of urology
Volume37
Issue number6
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Keywords

  • Fluorescence
  • Indocyanine green
  • Robotics
  • Ureteroenteric stricture

ASJC Scopus subject areas

  • Urology

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