Bricker ileal conduit diversion with ICG technique in 10 steps

Area of Science:

• Urology
• Surgical Oncology

Background:

• The Bricker ileal conduit is a standard incontinent urinary diversion after pelvic exenteration.
• Complications include fistulas and ureteral stenosis, particularly after extensive ureteral dissection in oncologic cases.
• Assessing tissue vascularization is crucial for successful ureteral anastomosis.

Purpose of the Study:

• To evaluate the utility of indocyanine green (ICG) fluorescence imaging in assessing ureteral and anastomotic vascularization during Bricker ileal conduit formation.
• To determine if ICG can help mitigate risks of fistula and stenosis in this procedure.

Main Methods:

• The Bricker ileal conduit involves creating a urinary diversion using a 20 cm ileal segment.
• Ureters are anastomosed to the proximal end of the ileal segment.
• Intravenous injection of indocyanine green (ICG) is used to visualize vascularity of the ureters and anastomoses.

Main Results:

• ICG is a safe and effective tool for assessing tissue perfusion in oncologic surgery.
• This technique aids in identifying adequate vascularization for ureteral and ileal anastomoses.
• Improved vascular assessment may lead to reduced rates of postoperative complications.

Conclusions:

• Indocyanine green (ICG) fluorescence imaging is a valuable adjunct for evaluating vascularity in Bricker ileal conduit surgery.
• Utilizing ICG can potentially decrease the incidence of ureteral stenosis and fistulas.
• This method enhances surgical precision in complex urinary diversion procedures.