The role of ureteric indocyanine green fluorescence in colorectal surgery: a retrospective cohort study.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2024-07-10 DOI:10.1007/s10151-024-02955-x

P Rogers, J Dourado, A Wignakumar, B Weiss, P Aeshbacher, Z Garoufalia, V Strassmann, S Emile, P Strzempek, S Wexner

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引用次数: 0

Abstract

Background: Ureteric injury (UI) is an infrequent but serious complication of colorectal surgery. Prophylactic ureteric stenting is employed to avoid UI, yet its efficacy remains debated. Intraoperative indocyanine green fluorescence imaging (ICG-FI) has been used to facilitate ureter detection. This study aimed to investigate the role of ICG-FI in identification of ureters during colorectal surgery and its impact on the incidence of UI.

Methods: A retrospective cohort study involving 556 consecutive patients who underwent colorectal surgery between 2018 and 2023 assessed the utility of routine prophylactic ureteric stenting with adjunctive ICG-FI. Patients with ICG-FI were compared to those without ICG-FI. Demographic data, operative details, and postoperative morbidity were analyzed. Statistical analysis included univariable regression.

Results: Ureteric ICG-FI was used in 312 (56.1%) patients, whereas 43.9% were controls. Both groups were comparable in terms of demographics except for a higher prevalence of prior abdominal surgeries in the ICG-FI group. Although intraoperative visualization was significantly higher in the ICG-FI group (95.3% vs 89.1%; p = 0.011), the incidence of UI was similar between groups (0.3% vs 0.8%; p = 0.585). Postoperative complications were similar between the two groups. Median stent insertion time was longer in the ICG-FI group (32 vs 25 min; p = 0.001).

Conclusion: Ureteric ICG-FI improved intraoperative visualization of the ureters but was not associated with a reduced UI rate. Median stent insertion time increased with use of ureteric ICG-FI, but total operative time did not. Despite its limitations, this study is the largest of its kind suggesting that ureteric ICG-FI may be a valuable adjunct to facilitate ureteric visualization during colorectal surgery.

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输尿管吲哚菁绿荧光在结直肠手术中的作用：一项回顾性队列研究。

背景：输尿管损伤（UI）是结直肠手术中一种不常见但却严重的并发症。预防性输尿管支架植入术可避免输尿管损伤，但其疗效仍存在争议。术中吲哚菁绿荧光成像（ICG-FI）已被用于输尿管检测。本研究旨在探讨 ICG-FI 在结直肠手术中识别输尿管的作用及其对 UI 发生率的影响：一项回顾性队列研究涉及 2018 年至 2023 年间接受结直肠手术的 556 例连续患者，该研究评估了常规预防性输尿管支架植入术与辅助 ICG-FI 的效用。使用 ICG-FI 的患者与未使用 ICG-FI 的患者进行了比较。对人口统计学数据、手术细节和术后发病率进行了分析。统计分析包括单变量回归：结果：312 例（56.1%）患者使用了输尿管 ICG-FI，而 43.9% 的患者为对照组。两组患者的人口统计学特征相当，只是ICG-FI组患者曾接受腹部手术的比例较高。虽然ICG-FI组的术中可见度明显更高（95.3% vs 89.1%；p = 0.011），但两组的UI发生率相似（0.3% vs 0.8%；p = 0.585）。两组的术后并发症相似。ICG-FI 组的中位支架插入时间更长（32 分钟 vs 25 分钟；p = 0.001）：结论：输尿管 ICG-FI 改善了术中输尿管的可视化，但并没有降低尿失禁率。使用输尿管 ICG-FI 后，中位支架插入时间增加，但总手术时间没有增加。尽管存在局限性，但这项研究是同类研究中规模最大的，表明输尿管 ICG-FI 可能是结直肠手术中促进输尿管可视化的重要辅助手段。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.