A Novel Technique Using Fluorescent Ureteral Catheter and Flexible Ureteroscope for Safe Laparoscopic Fenestration of Lymphocele after Kidney Transplantation

Abstract

Laparoscopic fenestration of a postrenal transplant lymphocele is associated with a risk of renal hilar vessel and ureteral injury. Consequently, determination of the incision line is difficult. We describe a case of a 73-year-old man with postrenal transplant lymphocele who underwent a laparoscopic fenestration. We report a surgical video containing a new technique of laparoscopic fenestration using a fluorescent ureteral catheter in combination with a flexible ureteroscope. The combination of a fluorescent ureteral catheter and flexible ureteroscope during surgery enabled us to determine the incision line safely and accurately. Intraoperative real-time visualization of the lymphocele and ureter using a fluorescent ureteral catheter and a flexible ureteroscope is safer than conventional methods for laparoscopic fenestration. To the best of our knowledge, this is the first report of this novel technique.

Usefulness of fluorescent ureteral catheter during laparoscopic residual ureterectomy

“…This is because conventional catheters may be difficult to visualize in cases with surrounding tissue adhesion, and the ureter cannot be recognized without touching the catheter‐inserted ureter 5 . Recently, a near‐infrared ray catheter (NIRC™) fluorescent ureteral catheter (NIRFUC; Nippon Covidien, Ltd, Tokyo, Japan) has been developed, enabling visualization of the ureter under near‐infrared irradiation 5,6 . Fluorescent ureteral catheters have been reported to prevent ureteral injury, especially in gastrointestinal and gynecological surgeries 5–7 …”

“…5 Recently, a near-infrared ray catheter (NIRC TM ) fluorescent ureteral catheter (NIRFUC; Nippon Covidien, Ltd, Tokyo, Japan) has been developed, enabling visualization of the ureter under near-infrared irradiation. 5,6 Fluorescent ureteral catheters have been reported to prevent ureteral injury, especially in gastrointestinal and gynecological surgeries. [5][6][7] In this case, we considered the use of a fluorescent ureteral catheter a suitable indication due to the potential difficulties in visually identifying the ureter and the anticipated extensive adhesion resulting from the previous open nephrectomy.…”

“…5,6 Fluorescent ureteral catheters have been reported to prevent ureteral injury, especially in gastrointestinal and gynecological surgeries. [5][6][7] In this case, we considered the use of a fluorescent ureteral catheter a suitable indication due to the potential difficulties in visually identifying the ureter and the anticipated extensive adhesion resulting from the previous open nephrectomy. The point of this surgery was to check and keep the fluorescent ureteral catheter in position because the catheter might fall out easily during surgery.…”

“… 5 Recently, a near‐infrared ray catheter (NIRC™) fluorescent ureteral catheter (NIRFUC; Nippon Covidien, Ltd, Tokyo, Japan) has been developed, enabling visualization of the ureter under near‐infrared irradiation. 5 , 6 Fluorescent ureteral catheters have been reported to prevent ureteral injury, especially in gastrointestinal and gynecological surgeries. 5 , 6 , 7 …”

“… 5 , 6 Fluorescent ureteral catheters have been reported to prevent ureteral injury, especially in gastrointestinal and gynecological surgeries. 5 , 6 , 7 …”