Applications of indocyanine green in robotic urology

Bates, Anthony; Patel, Vipul

doi:10.1007/s11701-016-0641-5

Cited by 27 publications

(27 citation statements)

References 30 publications

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“…ICG fluorescence has played an expanding role in robotic urological procedures in recent years [12]. ICG has been used to predict malignancy in renal lesions [13,14], facilitate superselective arterial clamping in robot-assisted partial nephrectomy [15], and a hybrid fluorescent ICG tracer has been used to help identify sentinel lymph nodes during robot-assisted prostatectomy [16].…”

Section: Discussionmentioning

confidence: 99%

Use of indocyanine green to minimise uretero‐enteric strictures after robotic radical cystectomy

et al. 2019

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Objective To evaluate the impact of indocyanine green (ICG) for assessing ureteric vascularity on the rate of uretero‐enteric stricture formation after robot‐assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD). Patients and methods We identified 179 patients undergoing RARC and ICUD between January 2014 and May 2017, and divided the patients into two groups based on the utilisation of ICG for the assessment of ureteric vascularity (non‐ICG group and ICG group). We retrospectively reviewed the medical records to identify the length of ureter excised. Demographic, perioperative outcomes (including 90‐day complications and readmissions), and the rate of uretero‐enteric stricture were compared between the two groups. The two groups were compared using the t‐test for continuous variables and the chi‐squared test for categorical variables. A P < 0.05 was considered statistically significant. Results A total of 132 and 47 patients were in the non‐ICG group and the ICG group, respectively. There were no differences in baseline characteristics and perioperative outcomes including operating time, estimated blood loss, and length of stay. The ICG group was associated with a greater length of ureter being excised during the uretero‐enteric anastomosis and a greater proportion of patients having long segment (>5 cm) ureteric resection. The median follow‐up was 14 and 12 months in the non‐ICG and ICG groups, respectively. The ICG group was associated with no uretero‐enteric strictures compared to a per‐patient stricture rate of 10.6% and a per‐ureter stricture rate of 6.6% in the non‐ICG group (P = 0.020 and P = 0.013, respectively). Conclusion The use of ICG fluorescence to assess distal ureteric vascularity during RARC and ICUD may reduce the risk of ischaemic uretero‐enteric strictures. The technique is simple, safe, and reproducible. Larger studies with longer follow‐up are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Use of indocyanine green to minimise uretero‐enteric strictures after robotic radical cystectomy

et al. 2019

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“…ICG is a tricarbocyanine dye that can be visualised under NIRF using a specialised charge-coupled device camera 18. In healthy renal parenchyma, the transporter bilitranslocase (deficient in renal tumour) binds ICG and appears fluorescent when perfused with ICG laden blood 19. It has been used in a urological operative setting as a real-time contrast agent.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, it is administered intravenously although intra-ureteric injection has also been performed 18. It demonstrates a high signal-to-noise ratio, good tissue penetrance and an excellent safety profile (adverse event rate of 0.34% including nausea, vomiting and rarely anaphylaxis) 18–20. Applications in urological surgery thus far have included partial nephrectomy and adrenalectomy (in clarifying tumour margins), selective renal clamping, ureteral reconstruction, radical prostatectomy (in sentinel lymph node dissection) and particularly in robotic surgery where tactile feedback is lost and visual cues are more important 18 21…”

Section: Discussionmentioning

confidence: 99%

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

2019

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Mullerian abnormalities such as uterine didelphys have an association with renal abnormalities. Ureteric ectopia must be considered as a differential diagnosis of incontinence. We describe the case of a 21-year-old woman who presented with low volume continuous incontinence with a history of right renal agenesis and uterus didelphys. A right kidney was not identified on CT intravenous pyelogram but excretory phase images suggested the presence of a right ureter. Diethylenetriaminepentaacetic acid renogram confirmed an area of perfusion consistent with a poorly functioning right kidney remnant. Cystoscopic investigation demonstrated an orthotopic left ureteric orifice, and an ectopic right ureteric orifice was identified in the posterior fornix of the right vagina. A laparoscopic right nephrectomy was performed, with a new application of indocyanine green aiding in identification of the right hypoplastic kidney with fluorescence imaging. The patient recovered well postoperatively and experienced complete resolution of incontinence, with preserved normal renal function.

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“…Future developments aim to decrease variability of performance with an overall shortening of the learning curve [10]. Indocyanine green, which can be used to identify vessel perfusion and differentiate tissue density, may be used in robotic surgery with the view to helping in intraoperative identification of vascular, neurological and oncological tissues [12].…”

Section: New Robotic Technologiesmentioning

confidence: 99%

Robotic Surgery, Is It the Future?

Elkak¹

2017

Tumor Res

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Applications of indocyanine green in robotic urology

Abstract: Indocyanine green is a fluorescent molecule with wide ranging applications in minimally invasive urological surgery. This article explores the utility of ICG assisted intraoperative fluorescence in robotic urology.

Cited by 27 publications

References 30 publications

Use of indocyanine green to minimise uretero‐enteric strictures after robotic radical cystectomy

Use of indocyanine green to minimise uretero‐enteric strictures after robotic radical cystectomy

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

Robotic Surgery, Is It the Future?

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