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Heimberger M, Stocchi L, Brennan E, Spaulding A, DeLeon M, Merchea A, Dozois E, Colibaseanu D. Can preoperative ureteral stent placement help in the intraoperative identification of iatrogenic ureteral injury? J Gastrointest Surg 2024; 28:903-909. [PMID: 38555016 DOI: 10.1016/j.gassur.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The benefits of prophylactic ureteral stent placement during colorectal surgery remain controversial. This study aimed to determine the incidence of ureteral injury in colorectal operations, assess the complications associated with stent usage, and determine whether their use leads to earlier identification and treatment of injury. METHODS This was a retrospective study of patients undergoing colorectal abdominal operations between 2015 and 2021. Variables were examined for possible association with ureteral stent placement. The primary study endpoint was ureteral injury identified within 30 days postoperatively. RESULTS Of 6481 patients who underwent colorectal surgery, 970 (15%) underwent preoperative ureteral stent placement. The use of stents was significantly associated with a higher American Society of Anesthesiologists classification, wound classification, and longer duration of surgery. A ureteral injury was identified in 28 patients (0.4%). Of these patients, 13 had no stent, and 15 had preoperative stents placed. After propensity matching, stent use was associated with an increased risk of hematuria and urinary tract infection. Ureteral injury was identified intraoperatively in 14 of 28 patients (50.0%) and was not associated with ureteral stent use (P = .45). CONCLUSION Iatrogenic ureteral injury was uncommon, whereas preoperative stent placement was relatively frequent. Earlier recognition of iatrogenic ureteral injury is not an expected advantage of preoperative ureteral stent placement.
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Affiliation(s)
- Mark Heimberger
- Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Luca Stocchi
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States.
| | - Emily Brennan
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Aaron Spaulding
- Department of Health Care Delivery Research, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Michelle DeLeon
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Amit Merchea
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Eric Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, United States
| | - Dorin Colibaseanu
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
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Delgadillo Chabolla LE, Alpuing Radilla LA, Koythong T, Sunkara S, Mendez Y, Wang Q, Guan X. Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection. Int J Med Robot 2024; 20:e2636. [PMID: 38757434 DOI: 10.1002/rcs.2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/15/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND To assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES). METHODS We conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection. RESULTS The study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98 ± 6.65 years. Operative time averaged 181.32 ± 53.94 min, with estimated blood loss at 45.57 ± 33.62 mL. Postoperative stay averaged 0.23 ± 0.47 days. No ICG-related complications occurred. CONCLUSION No complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis.
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Affiliation(s)
| | - Linda A Alpuing Radilla
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Tamisa Koythong
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sowmya Sunkara
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Yamely Mendez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Qianqing Wang
- Department of Minimally Invasive Gynecological Surgery, Xinxiang Central Hospital, Henan, China
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, USA
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Hebert KJ, Bearrick E, Anderson KT, Viers BR. High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction With Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes? Urology 2024:S0090-4295(24)00305-4. [PMID: 38754791 DOI: 10.1016/j.urology.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To determine the role of near-infrared fluorescence imaging (NIFI) combined with indocyanine green (ICG) to assess ureteral tissue perfusion in a benign genitourinary reconstruction cohort with a high prevalence of prior abdominopelvic radiation and surgery. MATERIALS AND METHODS A prospective, single-surgeon series, between June 2018 and April 2022, of patients who underwent open genitourinary reconstructive surgeries in which NIFI/ICG was utilized to intraoperatively assess ureteral tissue perfusion prior to ureteral anastomosis. Primary outcome was ureteroanastomotic stricture (UAS). Secondary outcomes included impact of NIFI/ICG on surgical decision-making and ureter resection length. RESULTS Thirty nine patients, median age 66, underwent 40 multimodality reconstructive surgeries during which NIFI/ICG was utilized in the open setting. Radiation-induced etiology was present in 32 of 40 (80%) patients. UAS occurred in 1 of 57 (1.8%) anastomoses with median follow-up of 23.4 months. Use of NIFI/ICG changed intraoperative decision-making in 63% of cases. Change in intraoperative decision-making was more common in patients with prior abdominopelvic radiation (66%) compared to non-radiated patients (13%), P = .007. Discordance between subjective (white-light) and objective (NIFI/ICG) ureteral perfusion (white-light) occurred in 61% of ureters. Mean length of resected ureter was higher following objective assessment with NIFI/ICG (3.6 cm) versus subjective assessment (white light) conditions (1.8 cm), P = .001. CONCLUSION Use of NIFI/ICG was associated with low rates of UAS at 2-year follow-up in a cohort with high prevalence of prior radiation. NIFI/ICG was associated with longer lengths of ureter resection and ureteral perfusion assessment discordance compared to subjective surgeon assessment under white-light conditions.
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Affiliation(s)
- Kevin J Hebert
- Department of Urology, Louisiana State University Health, Shreveport, LA.
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN
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Chen DC, Sandhu DS, O'Brien JS, Eapen R, Moon D, Goad J, Perera ML, Murphy DG, Lawrentschuk N, Kelly BD. Indocyanine green in minimally and maximally invasive genitourinary cancer surgery. BJU Int 2024; 133:400-402. [PMID: 38258546 DOI: 10.1111/bju.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- David C Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Devan S Sandhu
- Department of Medicine, Fiona Stanley General Hospital, Perth, Western Australia, Australia
| | - Jonathan S O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Renu Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Urology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Marlon L Perera
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Brian D Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Brollo PP, Puggioni A, Tumminelli F, Colangelo A, Biddau C, Cherchi V, Bresadola V. Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives. Surg Today 2024; 54:291-309. [PMID: 36593285 DOI: 10.1007/s00595-022-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review aims to provide a critical overview of the most recent literature about IUI prevention techniques in colorectal surgery. We performed a comprehensive and systematic review of studies published from 2000 to 2022 and assessed the use of techniques for ureteral injury prevention and intraoperative localization. 26 publications were included, divided into stent-based (prophylactic/lighted ureteral stent and near-infrared fluorescent ureteral catheter [PUS/LUS/NIRFUC]) and fluorescent dye (FD) groups. Costs, the percentage and number of IUIs detected, reported limitations, complication rates and other outcome points were compared. The IUI incidence rate ranged from 0 to 1.9% (mean 0.5%) and 0 to 1.2% (mean 0.3%) in the PUS/LUS/NIRFUC and FD groups, respectively. The acute kidney injury (AKI) and urinary tact infection (UTI) incidence rate ranged from 0.4 to 32.6% and 0 to 17.3%, respectively, in the PUS/LUS/NIRFUC group and 0-15% and 0-6.3%, respectively, in the FD group. Many other complications were also compared and descriptively analyzed (length-of-stay, mortality, etc.). These techniques appear to be feasible and safe in select patients with a high risk of IUI, but the delineation of reliable guidelines for preventing IUI will require more randomized controlled trials.
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Affiliation(s)
- Pier Paolo Brollo
- General Surgical Oncology Department, IRCCS CRO di Aviano (Istituto Nazionale Tumori), Aviano, Italy.
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy.
| | - Alessandro Puggioni
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Francesco Tumminelli
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Antonio Colangelo
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Carlo Biddau
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Vittorio Cherchi
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Bresadola
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
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Obermair HM, Scasso S, Laufer J, Obermair A. Use of indocyanine green for ureteric illumination and visualization. Int J Gynecol Cancer 2024; 34:643-644. [PMID: 38253383 DOI: 10.1136/ijgc-2023-005042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Affiliation(s)
- Helena M Obermair
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Santiago Scasso
- Gynaecology Department, British Hospital, Montevideo, Uruguay
| | - Joel Laufer
- School of Medicine, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
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Khalaf MH, Abdelrahman H, El-Menyar A, Afifi I, Kloub A, Al-Hassani A, Rizoli S, Al-Thani H. Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature. Front Surg 2024; 11:1345831. [PMID: 38419940 PMCID: PMC10899482 DOI: 10.3389/fsurg.2024.1345831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
For decades, indocyanine green (ICG) has been available for medical and surgical use. The indications for ICG use in surgery have expanded where guided surgery directed by fluorescence and near-infrared fluorescent imaging offers numerous advantages. Recently, surgeons have reported using ICG operative navigation in the emergency setting, with fluorescent cholangiography being the most common procedure. The utility of ICG also involves real-time perfusion assessment, such as ischemic organs and limbs. The rising use of ICG in surgery can be explained by the ICG's rapid technological evolution, accuracy, ease of use, and great potential to guide precision surgical diagnosis and management. The review aims to summarize the current literature on the uses of ICG in emergency general surgery. It provides a comprehensive and practical summary of the use of ICG, including indication, route of administration, and dosages. To simplify the application of ICG, we subdivided its use into anatomical mapping and perfusion assessment. Anatomical mapping includes the biliary tree, ureters, and bowel. Perfusion assessment includes bowel, pancreas, skin and soft tissue, and gonads. This review provides a reference to emergency general surgeons to aid in implementing ICG in the emergency setting for more enhanced and safer patient care.
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Affiliation(s)
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Ibrahim Afifi
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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Souli A, Alves A, Tillou X, Menahem B. Iatrogenic ureteral injury: What should the digestive surgeon know? J Visc Surg 2024; 161:6-14. [PMID: 38242812 DOI: 10.1016/j.jviscsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE OF THE STUDY Iatrogenic ureteral injury (IUI) is a rare but formidable complication of any abdominal or pelvic surgery. The aim of this study was to describe the epidemiology of IUI in colorectal surgery in the Basse-Normandie region over the period 2004-2022, as well as to review the literature on the management of this complication. MATERIALS AND METHODS This multicenter retrospective analysis of clinical data (medical records and operative reports) concerned 22 patients (13 men and 9 women) who suffered an IUI during colorectal surgery between 2004 and 2022. Ureteral resections for oncological purposes and endoluminal instrumental injuries (post-ureteroscopy) were excluded from the study. We also carried out a review of the literature concerning the incidence of IUI in colorectal surgery. RESULTS The incidence of IUI was 0.27% over the study period (22 ureteral injuries out of 8129 colorectal procedures). Colorectal cancer and sigmoid diverticulitis were the dominant surgical indications (85% of cases). Proctectomy and left colectomy were the most performed resection procedures (75% of cases). Surgery was scheduled in 68% of cases. The approach was open laparotomy in 59% and laparoscopy in 41% of cases. The IUI involved the left ureter in 63% of cases and the pelvic ureter in 77% of cases. Conservative endoscopic treatment by insertion of a double-J catheter stent had a success rate of 87.5%. Surgical repairs consisting of re-implantation techniques and uretero-ureteral anastomosis had a success rate of 75%. The nephrectomy rate was 13.6% (3/22) and the mortality rate 9% (2/22). A literature review identified sixteen studies, where the incidence of IUI varied from 0.1 to 4.5%. FINDINGS IUI occurring during colorectal surgery is a rare occurrence but remain a formidable complication. No means of prevention has proven its effectiveness to date, but guidance devices using illuminated ureteral catheters or dyes seem to constitute a promising approach. Injuries to the left pelvic ureter are the most common, and the majority can be treated endoscopically if diagnosed early.
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Affiliation(s)
- Abdelaziz Souli
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Arnaud Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France
| | - Xavier Tillou
- Department of urology, university hospital of Caen, Caen, France
| | - Benjamin Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France.
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Schmied ID, Rajkumar D, Chang MI, Colom SM, Cleary RK. Ureteral Stents Do Not Increase the Risk for Acute Kidney Injury After Colorectal Surgery. Dis Colon Rectum 2024; 67:151-159. [PMID: 37678267 DOI: 10.1097/dcr.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Ureteral stents are thought to prevent or help identify ureteral injuries. Studies suggesting that ureteral stents increase the risk of postoperative acute kidney injury show inconsistent conclusions. The large ureteral stenting volume at our institution provided a unique opportunity for granular analysis not previously reported. OBJECTIVE To determine whether prophylactic ureteral stenting at colorectal surgery increases acute kidney injury. DESIGN Retrospective analysis of colorectal operations with prophylactic ureteral stents was compared to operations without stents. Adjusted analysis was performed with inverse probability treatment weighting. SETTINGS Single institution enhanced recovery colorectal surgery service. PATIENTS Prospective institutional database between July 1, 2018, and December 31, 2021. MAIN OUTCOME MEASURE The primary outcome was acute kidney injury, defined as increase in creatinine ≥0. 3 mg/dL (definition 1) and 1.5-fold increase in creatinine (definition 2) within 48 hours postoperatively. RESULTS There were 410 patients in the study population: 310 patients in the stent group and 100 in the no-stent group. There were 8 operative ureteral injuries: 4 (1.29%) in the stent group and 4 (4.0%) in the no-stent group ( p = 0.103). Unadjusted analysis revealed no significant difference in acute kidney injury between groups. After adjustment, there was still no significant difference in acute kidney injury between groups when defined as definition 1 (no-stent 23.76% vs stent 26.19%, p = 0.745) and as definition 2 (no-stent 15.86% vs stent 14.8%, p = 0.867). Subgroup analysis showed that lighted stents were associated with significantly more acute kidney injury than no-stent patients when defined as definition 1 ( p = 0.017) but not when defined as definition 2 ( p = 0.311). LIMITATIONS Single-institution results may not be generalizable. CONCLUSION Prophylactic ureteral stenting does not increase the risk of acute kidney injury for patients undergoing enhanced recovery colorectal surgery, although caution and further study may be warranted for lighted stents. Studies further examining contrasting roles of ureter stenting and imaging in open and minimally invasive colorectal surgery are warranted. See Video Abstract. LOS STENTS URETERALES NO AUMENTAN EL RIESGO DE LESIN RENAL AGUDA DESPUS DE LA CIRUGA COLORECTAL ANTECEDENTES:Se cree que los stents ureterales previenen o ayudan a identificar las lesiones ureterales. Los estudios que sugieren que los stents ureterales aumentan el riesgo de lesión renal aguda post operatoria muestran conclusiones contradictorias. El gran volumen de endoprótesis ureterales en nuestra institución brindó una oportunidad única para el análisis granular que no se informó anteriormente.OBJETIVO:Determinar si la colocación de stent ureteral profiláctico en cirugía colorrectal aumenta el daño renal agudo.DISEÑO:El análisis retrospectivo de operaciones colorrectales con stents ureterales profilácticos se comparó con operaciones sin stents. El análisis ajustado se realizó con ponderación de tratamiento de probabilidad inversa.AJUSTES:Cirugía colorrectal de recuperación mejorada de una sola instituciónPACIENTES:Base de datos institucional prospectiva entre el 01/07/2018 y el 31/12/2021.MEDIDA DE RESULTADO PRINCIPAL:El resultado primario fue la lesión renal aguda definida como un aumento en la creatinina ≥ 0,3 mg/dL (Definición n.° 1) y un aumento de 1,5 veces en la creatinina (Definición n.° 2) dentro de las 48 horas posteriores a la operación.RESULTADOS:Hubo 410 pacientes en la población de estudio: 310 pacientes en el grupo Stent y 100 en el grupo No-Stent. Hubo 8 lesiones ureterales operatorias, 4 (1,29%) en el grupo Stent y 4 (4,0%) en el grupo No-Stent (p = 0,103). El análisis no ajustado no reveló diferencias significativas en la lesión renal aguda entre los grupos. Después del ajuste, todavía no hubo una diferencia significativa en la lesión renal aguda entre los grupos cuando se definió como Definición n.º 1 (sin stent 23,76 % frente a stent 26,19 %, p = 0,745) y por definición n.º 2 (sin stent 15,86 % frente a stent 14,8 %, p = 0,867). El análisis de sub grupos mostró que los stents iluminados se asociaron con una lesión renal aguda significativamente mayor que los pacientes sin stent cuando se definieron como Definición n.º 1 (p = 0,017), pero no cuando se los definió como Definición n.º 2 (p = 0,311).LIMITACIONES:Los resultados de una sola institución pueden no ser generalizables.CONCLUSIÓN:La colocación profiláctica de endoprótesis ureterales no aumenta el riesgo de lesión renal aguda en pacientes que se someten a cirugía colorrectal de recuperación mejorada, aunque es posible que se requiera precaución y estudios adicionales para las endoprótesis iluminadas. Se justifican estudios que examinen más a fondo las funciones contrastantes de la colocación de stents de uréter y las imágenes en la cirugía colorrectal abierta y mínimamente invasiva. (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Isaac D Schmied
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Dixy Rajkumar
- Department of Academic Research, St Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Melissa I Chang
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Sara M Colom
- Biostatistics and Epidemiology Methods Consulting, Ann Arbor, Michigan
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, Michigan
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Rahate NP, Kapse A, Rahate PV, Nimbhorkar SP. The Wonder Dye: Uses and Implications of Indigocyanine Green in Various Surgeries. Cureus 2023; 15:e46722. [PMID: 38021982 PMCID: PMC10630983 DOI: 10.7759/cureus.46722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Indigocyanine green (ICG) is a fluorophore dye that has been extensively used in recent modern times for bioimaging in numerous surgeries to aid in easier identification of occult and often tricky-to-find anatomical structures. Surgery becomes complex and challenging due to multiple anatomical anomalies, pathological fibrosis, obesity, or previous surgeries. To overcome these obstacles in surgery, the surgeon yearns to know the structures present beyond their white light vision so that while dissecting the organ, they can avoid injuring the critical systems in the vicinity of dissection. Near-infrared (NIR) imaging aids in visualising the tissues at depth/in the area of dissection, thereby preventing any possible surgical catastrophes due to them inadvertently damaging surrounding vital structures. Various advantages in surgeries like gastric sleeve surgery, lymph node and tumour detection, localisation of ureters and biliary tracts, and intraoperative tissue perfusion of flaps have been described in this study. This review article aims to compile a short list of utilities of ICG with NIR imaging in various surgical interventions. The merits and demerits of this imaging technique have been noted. The study points out the uses of ICG fluorescence imaging under different surgical fronts. This review article concludes by comparing the results of studies performed by various authors. Results have been compared to conventional surgical modalities.
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Affiliation(s)
- Nachiket P Rahate
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Kapse
- Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | | | - Sakshi P Nimbhorkar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lim ZY, Mohan S, Balasubramaniam S, Ahmed S, Siew CCH, Shelat VG. Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green. World J Gastrointest Surg 2023; 15:1841-1857. [PMID: 37901741 PMCID: PMC10600780 DOI: 10.4240/wjgs.v15.i9.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
Indocyanine green (ICG) is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery. ICG facilitates anatomical identification of structures (e.g., ureters), assessment of lymph nodes, biliary mapping, organ perfusion and anastomosis assessment, and aids in determining the adequacy of oncological margins. In addition, ICG can be conjugated to artificially created antibodies for tumour markers, such as carcinoembryonic antigen for colorectal, breast, lung, and gastric cancer, prostate-specific antigen for prostate cancer, and cancer antigen 125 for ovarian cancer. Although ICG has shown promising results, the optimization of patient factors, dye factors, equipment, and the method of assessing fluorescence intensity could further enhance its utility. This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies. With the emergence of robotic technology and the increasing reporting of ICG utility, a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.
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Affiliation(s)
- Zavier Yongxuan Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Swetha Mohan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | | | - Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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12
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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Kim J, Jang Y, Choi SH, Jung YW, Kim ML, Yun BS, Seong SJ, Jun HS. Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery. J Pers Med 2023; 13:1345. [PMID: 37763114 PMCID: PMC10532563 DOI: 10.3390/jpm13091345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP.
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Affiliation(s)
- Jiyoun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Yoon Jang
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Su Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang 10414, Republic of Korea;
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
| | - Hye Sun Jun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea; (J.K.); (Y.J.); (S.H.C.); (Y.W.J.); (M.-L.K.); (S.J.S.)
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14
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Khan MF, Emma K, O'Brien E, Galvin D, Walsh T, Cahill RA. NIR-ICG identification of ureters during complex colorectal and gynaecological operations: How to do it! - A video vignette. Colorectal Dis 2023; 25:528-529. [PMID: 36239664 DOI: 10.1111/codi.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Mohammad F Khan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kearns Emma
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Ellen O'Brien
- Department of Urological Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - David Galvin
- Department of Urological Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tom Walsh
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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15
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Garoufalia Z, Wexner SD. Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery. J Clin Med 2023; 12:jcm12020494. [PMID: 36675423 PMCID: PMC9865296 DOI: 10.3390/jcm12020494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Indocyanine green (ICG) imaging has been increasingly used for intraoperative guidance in colorectal surgery over the past decade. The aim of this study was to review and organize, according to different type of use, all available literature on ICG guided colorectal surgery and highlight areas in need of further research and discuss future perspectives. METHODS PubMed, Scopus, and Google Scholar databases were searched systematically through November 2022 for all available studies on fluorescence-guided surgery in colorectal surgery. RESULTS Available studies described ICG use in colorectal surgery for perfusion assessment, ureteral and urethral assessment, lymphatic mapping, and hepatic and peritoneal metastases assessment. Although the level of evidence is low, results are promising, especially in the role of ICG in reducing anastomotic leaks. CONCLUSIONS ICG imaging is a safe and relatively cheap imaging modality in colorectal surgery, especially for perfusion assessment. Work is underway regarding its use in lymphatic mapping, ureter identification, and the assessment of intraperitoneal metastatic disease.
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Chen K, Lawrentschuk N. Case of the Month from Peter MacCallum Cancer Centre, Melbourne, Australia: ICG-assisted robotic Boari flap ureteric reimplantation in a case of missed ureteric injury. BJU Int 2023; 131:46-49. [PMID: 36546722 DOI: 10.1111/bju.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kenneth Chen
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Nathan Lawrentschuk
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Vic., Australia
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Rodríguez-Zentner H, Cukier M, Montagne V, Arrue E. Ureteral identification with indocyanine green in laparoscopic colorectal surgery. Asian J Endosc Surg 2022; 16:312-316. [PMID: 36562203 DOI: 10.1111/ases.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. MATERIALS AND SURGICAL TECHNIQUE We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. RESULTS We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4 minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration. DISCUSSION Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.
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Affiliation(s)
- Homero Rodríguez-Zentner
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Moises Cukier
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Vianette Montagne
- Division of Urology, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Emmy Arrue
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
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Ishizawa T, McCulloch P, Stassen L, van den Bos J, Regimbeau JM, Dembinski J, Schneider-Koriath S, Boni L, Aoki T, Nishino H, Hasegawa K, Sekine Y, Chen-Yoshikawa T, Yeung T, Berber E, Kahramangil B, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for anatomy visualisation, using the IDEAL framework. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000156. [DOI: 10.1136/bmjsit-2022-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectivesIntraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: visualising anatomy, assessing tissue perfusion, identifying/localising cancer and mapping lymphatic systems. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging used to visualise anatomical structures using the IDEAL framework, a framework designed to describe the stages of innovation in surgery and other interventional procedures.DesignIDEAL staging based on a thorough literature review.SettingAll publications on intraoperative fluorescence imaging for visualising anatomical structures reported in PubMed through 2020 were identified for five surgical procedures: cholangiography, hepatic segmentation, lung segmentation, ureterography and parathyroid identification.Main outcome measuresThe IDEAL stage of research evidence was determined for each of the five procedures using a previously described approach.Results225 articles (8427 cases) were selected for analysis. Current status of research evidence on fluorescence imaging was rated IDEAL stage 2a for ureterography and lung segmentation, IDEAL 2b for hepatic segmentation and IDEAL stage 3 for cholangiography and parathyroid identification. Enhanced tissue identification rates using fluorescence imaging relative to conventional white-light imaging have been documented for all five procedures by comparative studies including randomised controlled trials for cholangiography and parathyroid identification. Advantages of anatomy visualisation with fluorescence imaging for improving short-term and long-term postoperative outcomes also were demonstrated, especially for hepatobiliary surgery and (para)thyroidectomy. No adverse reactions associated with fluorescent agents were reported.ConclusionsIntraoperative fluorescence imaging can be used safely to enhance the identification of anatomical structures, which may lead to improved postoperative outcomes. Overviewing current research knowledge using the IDEAL framework aids in designing further studies to develop fluorescence imaging techniques into an essential intraoperative navigation tool in each surgical field.
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Morales-Conde S, Licardie E, Alarcón I, Balla A. Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp 2022; 100:534-554. [PMID: 35700889 DOI: 10.1016/j.cireng.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain.
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy.
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20
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Burden of Colovesical Fistula and Changing Treatment Pathways: A Systematic Literature Review. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:577-585. [PMID: 36044282 DOI: 10.1097/sle.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Colovesical fistula (CVF) is a rare complication of sigmoid diverticulitis causing significant morbidity and quality of life impairment. Aim of this study was to analyze contemporary literature data to appraise the current standard of care and changes of treatment algorithms over time. MATERIALS AND METHODS A systematic review of the literature on surgical management of CVF was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. RESULTS Fourteen papers published between 2014 and 2020 and including 1061 patients were analyzed. One-stage colonic resection with primary anastomosis, with or without loop ileostomy, was the most common surgical procedure. A laparoscopic or robotic approach was attempted in 39.5% of patients, and conversion rate to open surgery was 7.8%. Clavien-Dindo grade ≥3 complication rate, 30-day mortality, and recurrence rate were 7.4%, 1.5%, and 0.5%, respectively. CONCLUSIONS Minimally invasive sigmoidectomy with primary anastomosis is safe and should be the first-choice approach for CVF. Bladder repair is not necessary after a negative intraoperative leak test. A standardized perioperative care can improve clinical outcomes and reduce the length of hospital stay and the duration of Foley catheterization.
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21
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Sucandy I, Ross S, Touadi M, Crespo K, Syblis C, Rosemurgy A. Robotic Resection of Retroperitoneal Perinephric Tumor. Application of Intraurethral Indocyanine Green Injection As an Adjunct to Avoid Ureteral Injury. Am Surg 2022:31348221083933. [PMID: 35289197 DOI: 10.1177/00031348221083933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of retroperitoneal mass excision is performed via conventional "open" laparotomy due to concerns of technical difficulty and adequate oncological margins in cases of a malignant sarcoma. A very few cases of minimally invasive resection by laparoscopy had been reported in the literature. Despite the rapid adoption of robotic technology in general surgery and surgical oncology, the robotic technique has not been applied for this pathology. We discussed a complete resection of a large perinephric tumor using a robotic platform. To our knowledge, this is the first study to report the robotic technique of retroperitoneal tumor excision, highlighting the application and usefulness of intraurethral indocyanine green (ICG) injection.
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Affiliation(s)
| | - Sharona Ross
- Digestive Health Institute, 4422AdventHealth Tampa, FL, USA
| | - Melissa Touadi
- Digestive Health Institute, 4422AdventHealth Tampa, FL, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, 4422AdventHealth Tampa, FL, USA
| | - Cameron Syblis
- Digestive Health Institute, 4422AdventHealth Tampa, FL, USA
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22
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Daniluk P, Mazur N, Swierblewski M, Chand M, Diana M, Polom K. Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends. Surg Innov 2022; 29:479-487. [PMID: 35232304 DOI: 10.1177/15533506211072678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fluorescence imaging in colorectal surgery is considered a novel predominantly intraoperative method of ensuring a greater surgical success. The use of fluorescence is linked to advanced tumor visualization and projection of its lymphatics, both vessels and nodes, which results in a higher chance of achieving a total excision. Additionally, iatrogenic complications prove to be reduced using fluorescence during the surgical excision. The combination of fluorescence and artificial intelligence to better facilitate oncological surgery will soon become an established approach in operating rooms worldwide.
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Affiliation(s)
- Paulina Daniluk
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Natalia Mazur
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Maciej Swierblewski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Manish Chand
- Department of Surgery and Interventional Sciences, GENIE Centre, 4919University College London, University College London Hospitals, NHS Trust, London, UK
| | - Michele Diana
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
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23
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Hayakawa S, Ogawa R, Ueno S, Ito S, Okubo T, Sagawa H, Tanaka T, Takahashi H, Matsuo Y, Mitsui A, Kimura M, Takiguchi S. Impact of the indocyanine green fluorescence method for anastomotic blood flow in robotic distal gastrectomy. Surg Today 2022; 52:1405-1413. [PMID: 35199250 DOI: 10.1007/s00595-022-02476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the blood flow at the site of delta-shaped anastomosis during robotic distal gastrectomy and determine surgical outcomes and risk factors for ischemia at the anastomotic site from the perspective of clinical characteristics, surgical outcomes and perigastric vascular anatomy. METHODS We included 55 patients who underwent robotic distal gastrectomy with a blood flow evaluation in the duodenal walls using intravenous indocyanine green injection with the da Vinci Xi-equipped Firefly system. Additional resection was performed in patients with a poor blood flow. Clinical characteristics, surgical outcomes and perigastric vascular anatomy were compared between the 45 patients with sufficient blood flow (group S) and the 10 patients with insufficient blood flow (group I). Vascular anatomy was assessed by preoperative contrast-enhanced computed tomography according to Hiatt's classification. RESULTS The patient characteristics and surgical outcomes were not significantly different. No patient developed anastomotic complications requiring intervention; more patients in group I had aberrant branching of the left hepatic artery than those in group S (p = 0.047). CONCLUSIONS An indocyanine green-based blood flow evaluation might be an effective method of preventing anastomotic complications of delta-shaped anastomosis. Anatomical branching variations of the left hepatic artery might be a risk factor for impaired vascular perfusion of the anastomotic site.
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Affiliation(s)
- Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan.
| | - Shuhei Ueno
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Sunao Ito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tomotaka Okubo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Hiroyuki Sagawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tatsuya Tanaka
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Akira Mitsui
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Masahiro Kimura
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
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24
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Guía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experiencia. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Mazzarella G, Muttillo EM, Picardi B, Rossi S, Rossi Del Monte S, Muttillo IA. Real-Time Intraoperative Ureteral Identification in Minimally Invasive Colorectal Surgery: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 32:627-633. [PMID: 34669486 DOI: 10.1089/lap.2021.0292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Although colorectal surgery (CRS) has currently almost entirely standardized surgical procedures, it can still show pitfalls such as the intraoperative ureteral injury. Intraoperative ureteral identification (IUI) could reduce the ureteral injuries rate but evidence is still lacking. We aimed to analyze the utility and the effectiveness of real-time IUI in minimally invasive CRS. Materials and Methods: A systematic review was performed examining available data on randomized and nonrandomized studies evaluating the utility of intraureteral fluorescence dye (IFD) and lighted ureteral stent (LUS) for intraoperative identification of ureters in CRS, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. Primary endpoint was ureteral injuries rate. Secondary endpoints included acute kidney injury, hematuria, urinary tract infections (UTI), and fluorescence assessment. Results: After literature search, 158 studies have been recorded, 36 studies underwent full-text reviews and 12 studies met inclusion criteria. Overall, out of a total of 822 patients who successfully received IUI, 3 (0.33%) patients experienced ureteral injury. Hematuria was reported in 689 (97.6%) of patients following LUS-guided surgery and in 1 (2%) patient following IFD-guided surgery, although transient in all cases. UTI was reported in 15 (3.3%) LUS-guided resections and in 1 (2%) IFD-guided resections. Acute kidney injury occurred in 23 (2.5%) LUS-guided surgery and 1 (1%) IFD-guided surgery. Conclusions: Real-time ureteral identification techniques could represent a valid solution in complex minimally invasive CRS, safely, with no time consuming and always reproducible by surgeons. Prospective studies will be needed to confirm these findings.
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Affiliation(s)
- Gennaro Mazzarella
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy.,Department of Emergency Surgery, Sapienza University of Rome, Rome, Italy
| | - Edoardo Maria Muttillo
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
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26
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Peltrini R, Podda M, Castiglioni S, Di Nuzzo MM, D'Ambra M, Lionetti R, Sodo M, Luglio G, Mucilli F, Di Saverio S, Bracale U, Corcione F. Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art. World J Gastroenterol 2021; 27:6374-6386. [PMID: 34720528 PMCID: PMC8517789 DOI: 10.3748/wjg.v27.i38.6374] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari 09100, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | | | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Gaetano Luglio
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Felice Mucilli
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese 21100, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
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27
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Galema HA, Meijer RPJ, Lauwerends LJ, Verhoef C, Burggraaf J, Vahrmeijer AL, Hutteman M, Keereweer S, Hilling DE. Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives. Eur J Surg Oncol 2021; 48:810-821. [PMID: 34657780 DOI: 10.1016/j.ejso.2021.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer is the fourth most diagnosed malignancy worldwide and surgery is one of the cornerstones of the treatment strategy. Near-infrared (NIR) fluorescence imaging is a new and upcoming technique, which uses an NIR fluorescent agent combined with a specialised camera that can detect light in the NIR range. It aims for more precise surgery with improved oncological outcomes and a reduction in complications by improving discrimination between different structures. METHODS A systematic search was conducted in the Embase, Medline and Cochrane databases with search terms corresponding to 'fluorescence-guided surgery', 'colorectal surgery', and 'colorectal cancer' to identify all relevant trials. RESULTS The following clinical applications of fluorescence guided surgery for colorectal cancer were identified and discussed: (1) tumour imaging, (2) sentinel lymph node imaging, (3) imaging of distant metastases, (4) imaging of vital structures, (5) imaging of perfusion. Both experimental and FDA/EMA approved fluorescent agents are debated. Furthermore, promising future modalities are discussed. CONCLUSION Fluorescence-guided surgery for colorectal cancer is a rapidly evolving field. The first studies show additional value of this technique regarding change in surgical management. Future trials should focus on patient related outcomes such as complication rates, disease free survival, and overall survival.
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Affiliation(s)
- Hidde A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands; Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Ruben P J Meijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, the Netherlands
| | - Lorraine J Lauwerends
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, the Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Merlijn Hutteman
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Denise E Hilling
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands.
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28
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Bobel MC, Altman A, Gaertner WB. Immunofluorescence in Robotic Colon and Rectal Surgery. Clin Colon Rectal Surg 2021; 34:338-344. [PMID: 34504405 DOI: 10.1055/s-0041-1729866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The indocyanine green fluorescence imaging system is a surgical tool with increasing applications in colon and rectal surgery that has received growing acceptance in various surgical disciplines as a potentially valid method to enhance surgical field visualization, improve lymph node retrieval, and decrease anastomotic leak. Small noncomparative prospective trials have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion and that its use may impact anastomotic leak rates. However, larger prospective and randomized studies are required to validate its role and impact in colorectal surgery. The purpose of this article is to review the current status of the use of immunofluorescence in colon and rectal surgery, as well as new applications in robotic colon and rectal resections.
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Affiliation(s)
- Matthew C Bobel
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ariella Altman
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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29
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Nishimuta M, Sumida Y, Araki M, Wakata K, Hamada K, Kugiyama T, Shibuya A, Hashimoto S, Ozeki K, Morino S, Kiya S, Baba M, Nakamura A. Safe laparoscopic resection of a giant schwannoma in the retroperitoneum using a fluorescent ureteral stent: a case report. J Surg Case Rep 2021; 2021:rjab350. [PMID: 34476075 PMCID: PMC8407031 DOI: 10.1093/jscr/rjab350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/24/2021] [Indexed: 12/03/2022] Open
Abstract
Schwannomas that occur in the retroperitoneal cavity are rare. We herein report a patient who underwent safe laparoscopic resection by using a preoperative 3D computed tomography (CT) image and a fluorescent ureteral stent during the surgery. A 47-year-old man presented with left lower abdominal pain. CT showed a 10-cm continuous retroperitoneal tumor originating at the third lumbar nerve in the lower left abdomen. Schwannoma was suspected. We underwent laparoscopic resection of the tumor guided by 3D images obtained preoperatively. A fluorescent ureteral stent was implanted during the surgery to improve visibility and protect the left ureter. The resection was completed without injury of other organs and vessels. The patient was discharged on postoperative Day 5. By performing a preoperative simulation using 3D CT images, we could anticipate the anatomical findings and easily identify them intraoperatively. In addition, the fluorescent ureteral stent provided visual support, thereby contributing to safe surgery.
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Affiliation(s)
- Masato Nishimuta
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Kouki Wakata
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Tota Kugiyama
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Ayako Shibuya
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Shintaro Hashimoto
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Keisuke Ozeki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Shigeyuki Morino
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Soichiro Kiya
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Masayuki Baba
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
| | - Akihiro Nakamura
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki 857-8511, Japan
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30
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Burke JF, Olson TP. Seeing green: Lighting up the ureters in minimally invasive colorectal surgery. Am J Surg 2021; 223:12-13. [PMID: 34489061 DOI: 10.1016/j.amjsurg.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Jocelyn F Burke
- Department of Surgery, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA.
| | - Terrah Paul Olson
- Department of Surgery, Division of Colorectal Surgery, Emory University, Atlanta, GA, USA
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31
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Soriano CR, Cheng RR, Corman JM, Moonka R, Simianu VV, Kaplan JA. Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections. Am J Surg 2021; 223:14-20. [PMID: 34353619 DOI: 10.1016/j.amjsurg.2021.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/01/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ureteral identification is essential to performing safe colorectal surgery. Injected immunofluorescence may aid with ureteral identification, but feasibility without ureteral catheterization is not well described. METHODS Case series of robotic colorectal resections where indocyanine green (ICG) injection with or without ureteral catheter placement was performed. Imaging protocol, time to ureteral identification, and factors impacting visualization are reported. RESULTS From 2019 to 2020, 83 patients underwent ureteral ICG injection, 20 with catheterization and 63 with injection only. Main indications were diverticulitis (52%) and cancer (36%). Median time to instill ICG was faster with injection alone than with catheter placement (4min vs 13.5min, p < 0.001). Median time [IQR] to right ureter (0.3 [0.01-1.2] min after robot docking) and left ureter (5.5 [3.1-8.8] min after beginning dissection) visualization was not different between injection alone and catheterization. CONCLUSION ICG injection alone is faster than with indwelling catheter placement and equally reliable at intraoperative ureteral identification.
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Affiliation(s)
- Celine R Soriano
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
| | - Ron Ron Cheng
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - John M Corman
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
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32
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Osumi W, Yamamoto M, Taniguchi K, Masubuchi S, Hamamoto H, Ishi M, Izuhara K, Tanaka K, Okuda J, Uchiyama K. Clinical experience with near-infrared ray catheter, a fluorescent ureteral catheter, on laparoscopic surgery for colon diverticulitis: A case report. Medicine (Baltimore) 2021; 100:e26085. [PMID: 34032744 PMCID: PMC8154449 DOI: 10.1097/md.0000000000026085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE As the world's population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery. PATIENTS CONCERN An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine. DIAGNOSES Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis. INTERVENTIONS After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal. OUTCOMES Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7. LESSONS The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.
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Affiliation(s)
- Wataru Osumi
- Department of General and Gastroenterological Surgery
| | | | | | | | | | | | | | | | - Junji Okuda
- Cancer Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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