Indocyanine green fluorescence-guided laparoscopic colorectal cancer surgery with prophylactic retrograde transileal conduit ureteral catheter placement after previous total cystectomy: a case report

Abstract

Background Iatrogenic ureteral injury (UI) is a potentially serious complication of colorectal cancer surgery. Performing perioperative placement of ureteral stents or intraoperative fluorescence navigation surgery for the ureter using indocyanine green (ICG) has been employed as a method of preventing UI. However, transileal conduit stent placement has been considered challenging because it is difficult to identify the ureteral orifice due to the anatomical changes caused by a previous surgery. We report a case in which laparoscopic colectomy was safely performed using a combination of prophylactic transileal conduit ureteral catheter placement and intraoperative ICG fluorescence navigation surgery. Case presentation A 75-year-old man presented to our hospital complaining of vomiting and abdominal distension. He had a history of open total cystectomy and ileal conduit urinary diversion 11 years prior to admission. Computed tomography confirmed colon dilation with fecal impaction from the ascending colon to the sigmoid colon and wall thickening in the sigmoid colon. Colonoscopy during the transanal ileus tube insertion revealed a Borrmann type II tumor with circumferential stenosis 10 cm distal to the junction between the descending colon and the sigmoid colon. The patient was diagnosed with colorectal ileus due to obstructive sigmoid colon cancer and underwent transanal ileus tube insertion. Severe intra-abdominal adhesions were expected due to the previous total cystectomy, and the left ureter was near the sigmoid colon tumor; therefore, prophylactic retrograde transileal conduit ureteral catheter placement was performed one day before the elective surgery. During the operation, 20 ml (5.0 × 10–2 mg/ml) ICG was administered from the transileal conduit ureteral catheter, and ICG fluorescence of the ureter was observed in the retroperitoneum. Laparoscopic Hartmann's operation was successfully performed, confirming ureter fluorescence. The operation time was 231 min, with 5 mL of intraoperative bleeding. The ureteral catheter was removed 3 days after the operation. The patient’s postoperative course was good with no complications, and he was discharged on postoperative day 7. Conclusions Prophylactic transileal conduit ureteral catheter placement and ICG fluorescence navigation surgery were effective in performing laparoscopic colorectal surgery with severe adhesions after urinary diversion.

Prevention of ureteral injury during laparoscopic colorectal cancer surgery with horseshoe kidney using fluorescent ureteral catheters: a case report

“…In abdominal surgery, the incidence of iatrogenic ureteral injury is estimated to be between 0.3% and 1.5% [ 14 ]. Risk factors for ureteral injury included a history of pelvic surgery, inflammatory bowel disease, endometriosis, and congenital renal abnormalities [ 6 , 7 , 10 ]. Ureteral catheter placement is a procedure used to prevent ureteral injury in such cases.…”

“…However, fluorescent ureteral catheters can guide the visual identification of the ureter in real-time even during laparoscopic surgery, which is a significant advantage over imaging modalities such as CT. The use of fluorescent ureteral catheters has enabled the ureter to be safely preserved in laparoscopic surgery even for cases of severe adhesions in diverticulitis or colorectal cancer surgery after total cystectomy [ 9 , 10 ]. In recent years, robotic abdominal surgery has become widespread.…”

“…The risk of ureteral injury is higher in laparoscopic surgery than in open surgery because of the difficulty in identifying the ureter by palpation [4][5][6][7]. Several studies have reported that fluorescent ureteral catheters guide the identification of the ureter in real-time and reduce the risk of ureteral injury during surgery [8][9][10]. However, no reports have been published regarding performing surgery for colorectal cancer with a horseshoe kidney using intraoperative navigation with fluorescent ureteral catheters.…”

Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends

“…study ICG was injected retrogradely via cystoscopy allowing to clearly localize both ureters during TME [2]. Left ureter can be protected by using the transileal conduit ureteral catheter when it is located near the sigmoid tumor while using an ICG-FI laparoscopy [17].…”

“…Left ureter can be protected by using the transileal conduit ureteral catheter when it is located near the sigmoid tumor while using an ICG-FI laparoscopy. 17 White et al 18 administered ICG intraureterally using cystoscopy with a successful identification in 94% of patients who underwent adjunctive ureteral identification during robot-assisted CRS. The identification of ureters is considered sensitive, safe, and cost-effective, especially when the technique to merely insert the tip of the ureteral catheter up to 1 cm into the vesicoureteric junctions, helps to reduce the complications related to ureteral catheterization.…”