Fluorescence ureteral navigation in laparoscopic Hartmann's procedure after aortic repair: a case report

Ureteral injury is a critical complication of colorectal surgery, particularly in reoperative fields where severe adhesions obscure the dissection layer. A near-infrared fluorescent ureteral catheter (NIRFUC) provides real-time ureteral visualization, thereby enhancing intraoperative safety.

An 81-year-old male on dialysis for diabetic nephropathy was referred for evaluation of a positive fecal occult blood test. Lower gastrointestinal endoscopy revealed a 0-IIc lesion in the sigmoid colon, pathologically confirmed as moderately differentiated adenocarcinoma. The patient had previously undergone open Y-graft replacement for an abdominal aortic aneurysm. Laparoscopic Hartmann's procedure was selected due to a high risk of anastomotic failure. Because difficulty in ureteral identification was anticipated, bilateral NIRFUCs were placed cystoscopically under fluoroscopy. The operation was completed uneventfully in 4 hours and 16 minutes. Postoperative ischemic colitis (Clavien-Dindo grade II) resolved without stoma complications. The final pathological stage was pT1bN0M0, Stage I.

The NIRFUC enabled safe ureteral identification in a complex reoperative field with severe fibrosis. Continuous visualization appeared to facilitate adherence to the embryological plane and safe dissection without ureteral injury, despite a nonstandard lateral approach. This technique appeared to be particularly useful when anatomical landmarks were obscured and may help support intraoperative decision-making in selected complex cases.

This case demonstrates the utility of the NIRFUC in laparoscopic colorectal redo surgery with severe adhesions. The NIRFUC may improve intraoperative safety by supporting anatomic orientation and facilitating safe dissection without ureteral complications in complex cases.