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Ureteral navigation using a fluorescent ureteral catheter during laparoscopic colorectal surgery

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Abstract

Background

Ureteral injury is the most common urological complication of pelvic surgery, with a reported incidence during colon resection of 0.3–1.5%. Ureteral stenting is commonly performed preoperatively to prevent ureteral injury. Because tactile sensation is not reliable during laparoscopic surgery, the effect of the ureteral stent is considered limited. Recently, fluorescence imaging has been used in laparoscopic surgery. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) is a new catheter with built-in NIR fluorescent resin. This pilot study was performed to evaluate the utility of fluorescence ureteral navigation using the NIRFUC during laparoscopic colorectal surgery.

Methods

We evaluated the intraoperative utility of the NIRFUC and the short-term outcomes in 20 patients treated with colorectal surgery at Kawaguchi Municipal Medical Center between February and July 2020. In all, 18 patients with malignant tumors and 2 patients with benign disease, i.e., a sigmoid colovesical fistula, were included. Ten patients developed preoperative intestinal obstruction. One patient experienced preoperative perforation. Nine patients developed preoperative peritumoral abscesses. Laparoscopic surgery was performed with the VISERA ELITE2 system.

Results

In all cases, the ureters were very clearly identified as fluorescent without the need for dissection. In all cases, only a moment was required to identify the ureter by fluorescence observation. In all cases, R0 resection was performed. The mean surgical duration was 334 min (161–1014), the mean blood loss was 10 ml (1–500), and the mean postoperative hospital stay was 11 days (8–47). There were no cases of ureteral injury.

Conclusion

The NIRFUC was very clearly identified as fluorescent in a moment during surgery without dissection around the ureter. Fluorescence ureteral navigation using the NIRFUC may make colorectal surgery easier and facilitate completion of complex minimally invasive surgery, especially during surgery in patients with invasion of the surrounding tissue or a history of pelvic surgery or radiation.

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Acknowledgements

The authors would like to thank Professor Masashi Yoshida (Department of Surgery, International University of Health and Welfare Hospital) for his invaluable advice regarding fluorescence navigation surgery. The authors would like to thank the medical staff of the Kawaguchi Municipal Medical Center, especially Ms. Keika Iijima for her assistance with the colorectal cancer database. Finally, the authors especially thank Sho Ohno, Yusuke Sasaki, and Taketo Ichinose (Department of urology, Kawaguchi Municipal Medical Center).

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Authors and Affiliations

  1. Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan

    Shunjin Ryu, Atsuko Okamoto, Keigo Nakashima, Keigo Hara, Kota Ishida, Ryusuke Ito & Yukio Nakabayashi

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  1. Shunjin Ryu
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  2. Atsuko Okamoto
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Correspondence to Shunjin Ryu.

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Disclosures

Shunjin Ryu, Atsuko Okamoto, Keigo Nakashima, Keigo Hara, Kota Ishida, Ryusuke Ito, Yukio Nakabayashi have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) (Approval number: 2020–3).

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Ryu, S., Okamoto, A., Nakashima, K. et al. Ureteral navigation using a fluorescent ureteral catheter during laparoscopic colorectal surgery. Surg Endosc 35, 4882–4889 (2021). https://doi.org/10.1007/s00464-021-08538-3

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