Use of Indocyanine Green During Robot-assisted Ureteral Reconstructions

Lee, Ziho; Moore, Blake W.; Giusto, Laura; Eun, Daniel

doi:10.1016/j.eururo.2014.08.057

Cited by 134 publications

(71 citation statements)

References 21 publications

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“…Clinical imaging of ICG in the NIR has already shown value for angiography in ophthalmology, intraoperative assessment of blood vessel patency in tissue graft, bypass surgeries, and intracranial aneurism surgeries (1,5,(56)(57)(58)(59). Noninvasive imaging of lymphatic vasculature using ICG has also been described for surgical mapping and intraoperative identification of sentinel nodes, imaging nodes following surgical excision, and evaluation and monitoring of lymphedema (1,5,60,61). Increasingly, ICG fluorescence imaging is also being used in robot-assisted surgery, in which the surgeon relies on visual cues instead of tactile feedback (7,11,61).…”

Section: Significancementioning

confidence: 99%

“…Noninvasive imaging of lymphatic vasculature using ICG has also been described for surgical mapping and intraoperative identification of sentinel nodes, imaging nodes following surgical excision, and evaluation and monitoring of lymphedema (1,5,60,61). Increasingly, ICG fluorescence imaging is also being used in robot-assisted surgery, in which the surgeon relies on visual cues instead of tactile feedback (7,11,61). However, full clinical implementation has been partially limited by insufficient image quality in deep operating fields.…”

Section: Significancementioning

confidence: 99%

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Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green

Carr

Franke

Caram

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

538

539

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Fluorescence imaging is a method of real-time molecular tracking in vivo that has enabled many clinical technologies. Imaging in the shortwave IR (SWIR; 1,000–2,000 nm) promises higher contrast, sensitivity, and penetration depths compared with conventional visible and near-IR (NIR) fluorescence imaging. However, adoption of SWIR imaging in clinical settings has been limited, partially due to the absence of US Food and Drug Administration (FDA)-approved fluorophores with peak emission in the SWIR. Here, we show that commercially available NIR dyes, including the FDA-approved contrast agent indocyanine green (ICG), exhibit optical properties suitable for in vivo SWIR fluorescence imaging. Even though their emission spectra peak in the NIR, these dyes outperform commercial SWIR fluorophores and can be imaged in the SWIR, even beyond 1,500 nm. We show real-time fluorescence imaging using ICG at clinically relevant doses, including intravital microscopy, noninvasive imaging in blood and lymph vessels, and imaging of hepatobiliary clearance, and show increased contrast compared with NIR fluorescence imaging. Furthermore, we show tumor-targeted SWIR imaging with IRDye 800CW-labeled trastuzumab, an NIR dye being tested in multiple clinical trials. Our findings suggest that high-contrast SWIR fluorescence imaging can be implemented alongside existing imaging modalities by switching the detection of conventional NIR fluorescence systems from silicon-based NIR cameras to emerging indium gallium arsenide-based SWIR cameras. Using ICG in particular opens the possibility of translating SWIR fluorescence imaging to human clinical applications. Indeed, our findings suggest that emerging SWIR-fluorescent in vivo contrast agents should be benchmarked against the SWIR emission of ICG in blood.

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Section: Significancementioning

confidence: 99%

Section: Significancementioning

confidence: 99%

Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green

Carr

Franke

Caram

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

538

539

View full text Add to dashboard Cite

show abstract

“…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]. Intra-ureteric ICG injection may also aid identification and localisation of ureteric strictures in robot-assisted ureteric reconstruction [17].…”

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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“…It is a widely used fluorescent dye in numerous surgical fields and would be an ideal fluorophore for ureteric fluorescence; however, as it binds to plasma proteins it is thus excreted via the hepatobiliary system [21], and therefore does not reach the ureter when injected intravenously. Direct ureteral injection with ICG is possible and has been reported in a number of patients [22–24] but still requires instrumentation of the bladder and ureteric orifice. Fluorophores that are renally excreted with similar emission wavelengths to ICG are currently in development.…”

Section: Discussionmentioning

confidence: 99%

Methylene blue fluorescence of the ureter during colorectal surgery

et al. 2018

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BackgroundIatrogenic ureteric injury is a serious complication of colorectal surgery. Incidence is estimated to be between 0.3 and 1.5%. Of all ureteric injuries, 9% occur during colorectal procedures. Ureteric stents are utilised as a method to reduce the risk of injury; however, these are not without risk and do not guarantee prevention of injury. Fluorescence is a safe and effective alternative for intraoperative ureteric localisation. This proof of principle study aims to assess the use of methylene blue to fluoresce the ureter during colorectal surgery.MethodPatients undergoing elective colorectal surgery were included in this open label, non-randomised study. Methylene blue was administered intravenously at varying doses (0.25–1 mg/kg) over 5 min, 10–15 min prior to entering ‘ureteric territory.’ Fluorescence was assessed using the PINPOINT Deep Red laparoscopic system at fixed time points by the surgeon and an independent observer.Results42 patients received methylene blue; 2 patients were excluded from analysis. Of the 69 ureters assessed, 64 were seen under fluorescence. Of these, 14 were not visible under white light. 50 ureters were observed with both fluorescence and white light with 14 of these being seen earlier with fluorescence. In ten cases, fluorescence revealed the ureter to be in a different location than suspected.ConclusionFluorescence is a promising method to allow visualisation of the ureter, where it is not identified easily under standard operative conditions, thereby improving safety and reducing operative time and difficulty.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6219-8) contains supplementary material, which is available to authorized users.

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Use of Indocyanine Green During Robot-assisted Ureteral Reconstructions

Cited by 134 publications

References 21 publications

Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green

Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green

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

Methylene blue fluorescence of the ureter during colorectal surgery

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