V10-01: Intraureteral Indocyanine Green to Facilitate Robotic Ureterolysis in Patients with Ureteral Obstruction due to Retroperitoneal Fibrosis
VideoIntroductions and Objectives
Retroperitoneal fibrosis (RPF) may lead to ureteral obstruction. Ureterolysis for the surgical management RPF may be complicated by fibrotic ureteral encasement, obliteration of normal dissection planes, and distorted anatomy. Indocyanine green (ICG), a dye that may be visualized under near-infrared fluorescence (NIRF), is well suited for surgical use due to its high signal-to-noise ratio, tissue penetration, and excellent safety profile.
Six patients with ureteral obstruction due to RPF underwent 7 robotic ureterolyses with intraureteral ICG injection. All patients consented to off-label use of ICG after full disclosure. Our technique involved using a ureteral catheter to inject 10 ml ICG retrograde into the ureter, above and below the level of obstruction. Intraoperatively, we used NIRF to visualize the green-fluoresced ureter.
Our technique allowed for definitive identification of the ureter and assisted in the successful completion of all cases. Mean age of patients was 47±18 years, BMI was 30±6 kg/m2, operative time was 202±95 min, EBL was 121±117 ml, and length of stay was 1.5±0.5 days. There were no intraoperative and postoperative complications. At a mean follow-up of 7.5±4.8 months, all patients had no radiographic evidence of ureteral obstruction recurrence.
In the setting of RPF, intraureteral ICG and visualization under NIRF facilitates ureterolysis by aiding in precise localization of the ureter. In our experience, our technique is simple and safe to perform.