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

被引：66

作者：

Ahmadi, Nariman ^{[1
]}

Ashrafi, Akbar N. ^{[1
]}

Hartman, Natalie ^{[1
]}

Shakir, Aliasger ^{[1
]}

Cacciamani, Giovanni E. ^{[1
]}

Freitas, Daniel ^{[1
]}

Rajarubendra, Nieroshan ^{[1
]}

Fay, Carlos ^{[1
]}

Berger, Andre ^{[1
]}

Desai, Mihir M. ^{[1
]}

Gill, Inderbir S. ^{[1
]}

Aron, Monish ^{[1
]}

机构：

[1] Univ Southern Calif, Keck Sch Med, USC Inst Urol, 1441 Eastlake Ave,Suite 7416, Los Angeles, CA 90089 USA

来源：

BJU INTERNATIONAL | 2019年 / 124卷 / 02期

关键词：

indocyanine green fluorescence; intracorporeal urinary diversion; robot-assisted radical cystectomy; uretero-enteric stricture; PARTIAL NEPHRECTOMY; URINARY-DIVERSION; FLUORESCENCE GUIDANCE; EXPERIENCE; ANASTOMOSIS;

D O I：

10.1111/bju.14733

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：302 / 307

页数：6

共 21 条

[1] Ureteroenteric Anastomotic Strictures After Radical Cystectomy-Does Operative Approach Matter? [J].