Related Experiment Video
Updated: Oct 14, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Cystoscopic submucosal indocyanine green marking in robot-assisted radical nephroureterectomy: a multicenter cohort
Runyi Wang1, Menghua Wu2, Haozhou Wang1
1Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Background:
Distal ureter and bladder cuff dissection can be difficult during robot-assisted radical nephroureterectomy (RA-RNU) for upper tract urothelial carcinoma (UTUC), particularly in the deep pelvis where tactile feedback is limited. We evaluated cystoscopic submucosal indocyanine green (ICG) marking around the ureteral orifice as a navigation aid for this step.
Methods:
Adults who underwent RA-RNU with formal bladder cuff excision for clinically localized UTUC (≤T3, M0) at three centers between January 2019 and November 2024 were retrospectively analyzed. Outcomes were compared between submucosal ICG-guided and conventional non-ICG procedures. The primary endpoint was video-derived distal ureter and bladder cuff identification time; postoperative care-process measures were descriptive, and other perioperative and oncological outcomes were exploratory.
Results:
The analysis included 82 patients (43 ICG, 39 non-ICG). The ICG group was older, and the largest baseline imbalances by SMD involved age and pathological T stage. Median identification time was 9.0 min with ICG and 19.3 min without ICG (p < 0.001). In the primary parsimonious model, the geometric mean ratio was 0.49 (HC3 95% CI 0.45-0.53; p < 0.001). No statistically significant between-group difference was observed in Clavien-Dindo grade. During exploratory follow-up, intravesical recurrence occurred in 1/43 versus 2/39 patients and extravesical recurrence in 3/43 versus 8/39; event counts were insufficient for comparative inference.
Conclusions:
Submucosal ICG marking around the ureteral orifice was associated with faster distal ureter and bladder cuff identification during RA-RNU. Prospective studies are needed to confirm reproducibility and evaluate injection-specific safety and longer-term oncological outcomes.