Indocyanine green angiography for preserving the ureteral branch of the uterine artery during radical hysterectomy

Abstract

Rationale:Conventional radical hysterectomy is frequently associated with postoperative ureteral ischemic necrosis, urinary fistula, stenosis, and kidney seeper. Some have suggested that preserving the ureteral branch during radical hysterectomy may reduce the incidence of ureteral complications. However, the feasibility of such preservation has not been explored using intraoperative imaging techniques.Patient concerns:Two cervical cancer patients aged 45 and 53 years were selected to undergo surgery in our hospital in October 2017. Both patients showed normal function of major organs and no special treatment was deemed necessary based on their subjective symptoms and preoperative examination.Diagnoses:Both patients were diagnosed with cervical cancer in stage Ib1 according to the staging scheme of the International Federation of Gynecology and Obstetrics (FIGO 2009).Interventions:Two patients underwent ureteral branch-sparing radical hysterectomy. During surgery, indocyanine green (ICG) fluorescence angiography was used to identify the ureteral branch and evaluate perfusion of the uterine artery, its ureteral branch and the ureter.Outcomes:The uterine artery and ureteral branch were clearly labeled by green fluorescence, as were the distal serous layer of the ureter and tissue supplied by the ureteral branch. During 4-month follow-up, neither patient suffered hydronephrosis, ureteral fistula or stricture.Lessons:ICG angiography is a useful intraoperative imaging technique for identifying the ureteral branch and evaluating the branch-sparing surgery. Based on real-time angiography, sparing the ureteral branch can maintain blood supply to the ureter distal serous layer and neighboring tissues.

Robot‐assisted modified radical hysterectomy with removal of lymphatic vessel using indocyanine green: A new method

“…Indocyanine green fluorescence peaked 2–3 min after intravenous injection. The uterine artery and ureteral branch were clearly labelled by green fluorescence, as were the distal serous layer of the ureter and tissue supplied by the ureteral branch 18 . He et al.…”

Application of indocyanine green fluorescence for ureter imaging: review

“…In two cases report by Ying Long et al successful isolation and preservation of the ureteral branch of the uterine artery during radical hysterectomy with IV-ICG angiography for cervical cancer was demonstrated [14]. This procedure prevents damage to the ureteral branch with subsequent ischemia of the distal ureter leading to its necrosis and stricture.…”

Utility of indocyanine green injection in patients with cervical cancer besides the identification of sentinel lymph node (Review)

“…Once this branch is identified, it will be more easily preserved, providing a better blood supply for the ureters. In an experimental study conducted by Long et al (26) published in 2018 this method was successfully used in two cervical cancer patients, at a four month follow-up neither case had developed any kind of urinary tract complication such as ureteral stricture, fistula or hydronephrosis.…”