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Use of indocyanine green to minimise uretero-enteric strictures after robotic radical cystectomy.
- Source :
-
BJU international [BJU Int] 2019 Aug; Vol. 124 (2), pp. 302-307. Date of Electronic Publication: 2019 Apr 11. - Publication Year :
- 2019
-
Abstract
- 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).<br />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.<br />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).<br />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.<br /> (© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Clinical Decision-Making
Constriction, Pathologic etiology
Constriction, Pathologic prevention & control
Female
Humans
Male
Middle Aged
Postoperative Complications etiology
Retrospective Studies
Ureteral Obstruction etiology
Urinary Diversion adverse effects
Coloring Agents
Cystectomy adverse effects
Indocyanine Green
Postoperative Complications prevention & control
Robotic Surgical Procedures adverse effects
Ureteral Obstruction prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1464-410X
- Volume :
- 124
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- BJU international
- Publication Type :
- Academic Journal
- Accession number :
- 30815976
- Full Text :
- https://doi.org/10.1111/bju.14733