Intraoperative bladder visualization by indocyanine green filling and subsequent washout in endoscopic hysterectomy: ICG-Washout method

IF 0.9 Q4 ORTHOPEDICS Asian Journal of Endoscopic Surgery Pub Date : 2024-04-30 DOI:10.1111/ases.13315

Akiko Yoshida Ueno, Takayuki Sato, Takaomi Namba, Fumie Kawase, Junko Komatsu, Kazutoshi Hayashi

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Abstract

Introduction

Despite a potential risk of bladder injury in laparoscopic hysterectomy (LH) and robot-assisted LH (RaLH), an intraoperative method for delineating the entire bladder with indocyanine green (ICG) has not been established.

Methods

We conducted a preliminary experiment using porcine bladders to verify the appropriate amount of ICG for intraoperative bladder visualization. Afterward, intraoperative bladder visualization was tried in LH and RaLH in two patients suspected of having adhesions around the bladder after previous abdominal surgery.

Results

Although near-infrared (NIR) fluorescence was well observed through the wall of the porcine bladder filled with ICG solution at a concentration of 0.024 mg/mL, the subsequent replacement of the ICG solution with saline made the NIR fluorescence brighter. In both patients, the bladder was successfully delineated by NIR fluorescence after filling the bladder with ICG solution and the subsequent washout with saline.

Conclusion

The ICG-Washout method for locating the bladder by NIR fluorescence could be useful in LH and RaLH.

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在内窥镜子宫切除术中通过吲哚菁绿填充和随后冲洗术中膀胱显像：ICG-冲洗法

引言尽管腹腔镜子宫切除术（LH）和机器人辅助 LH（RaLH）存在膀胱损伤的潜在风险，但术中用吲哚菁绿（ICG）描绘整个膀胱的方法尚未确立。方法我们使用猪膀胱进行了初步实验，以验证术中膀胱显像 ICG 的适当用量。随后，我们对两名疑似腹部手术后膀胱周围粘连的患者进行了 LH 和 RaLH 术中膀胱显像试验。结果虽然在猪膀胱内注入浓度为 0.024 毫克/毫升的 ICG 溶液后，可透过膀胱壁观察到近红外（NIR）荧光，但随后用生理盐水取代 ICG 溶液后，近红外荧光变得更亮。在这两名患者的膀胱中注入 ICG 溶液并随后用生理盐水冲洗后，近红外荧光成功地勾勒出了膀胱的轮廓。结论利用近红外荧光定位膀胱的 ICG 冲洗法可用于 LH 和 RaLH。

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