Indocyanine green fluorescence imaging for laparoscopic complex upper urinary tract reconstructions: a comparative...

Area of Science:

• Urology
• Surgical Innovation
• Medical Imaging

Background:

• Challenging upper urinary tract reconstructions (UUTRs) present significant surgical difficulties.
• Accurate visualization of ureteral anatomy is crucial for successful UUTR outcomes.

Purpose of the Study:

• To describe a novel technique using intraureteral indocyanine green (ICG) injection and near-infrared fluorescence (NIRF) visualization for UUTRs.
• To compare the outcomes of UUTRs performed with and without ICG/NIRF assistance.

Main Methods:

• A comparative study of 36 patients undergoing laparoscopic UUTRs between April 2019 and March 2020.
• Patients were divided into an ICG group (n=18) and a non-ICG group (n=18).
• Demographic, perioperative, and functional outcomes were analyzed.

Main Results:

• The ICG group demonstrated significantly shorter intraoperative ureter identification time (20.9 vs. 30.0 min, P=0.03) and length of postoperative hospital stay (11.1 vs. 16.6 days, P=0.03).
• Trends towards reduced stricture identification time and estimated blood loss were observed in the ICG group.
• Follow-up suggested a trend towards fewer severe complications in the ICG group.

Conclusions:

• Intraureteral ICG visualization under NIRF is a valuable tool for challenging UUTRs.
• The technique facilitates rapid ureteral identification and precise delineation of stricture margins.
• ICG/NIRF assistance in UUTRs yields encouraging perioperative and follow-up outcomes.