Urethral Visualization Using Near-infrared Light Observation During Transanal/Perineal Total Mesorectal Excision

Transanal total mesorectal excision is a useful technique while performing lower rectal cancer and deep pelvic surgery. However, it is a relatively difficult procedure, and unique complications such as urethral injury have been reported. Although there have been a few reports on urethral visualization, we investigated whether it is possible to visualize the urethra using a fluorescent urethral catheter.

We retrospectively examined the background and short-term surgical outcomes in 17 patients who, between April 2022 and December 2023, underwent transanal total mesorectal excision and transperineal total mesorectal excision with fluorescent ureteral catheters in place due to high risk of urethral injury.

The urethra was recognized in one out of 11 patients (9.1%) in laparoscopic abdominoperineal resection and all three patients (100%) in laparoscopic total pelvic extenteration. No urethral injury was observed.

Visualization of the urethra by inserting a fluorescent ureteral catheter may prevent urethral injury in patients undergoing transanal/transperineal total mesorectal excision who are at high risk of urethral injury.