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

Autor: Lee Z; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA. ziho.lee@gmail.com., Sterling ME; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA., Keehn AY; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA., Lee M; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA., Metro MJ; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA., Eun DD; Department of Urology, Temple University School of Medicine, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2019 Jun; Vol. 37 (6), pp. 1211-1216. Date of Electronic Publication: 2018 Sep 18.
DOI: 10.1007/s00345-018-2493-2
Abstrakt: 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.
Databáze: MEDLINE
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