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World Journal of Urology

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01-06-2019 | Original Article

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

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

Published in: World Journal of Urology | Issue 6/2019

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.

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Title: The use of indocyanine green during robotic ureteroenteric reimplantation for the management of benign anastomotic strictures
Authors: Ziho Lee
Matthew E. Sterling
Aryeh Y. Keehn
Matthew Lee
Michael J. Metro
Daniel D. Eun
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 6/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2493-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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