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TROUBLESHOOTING IN MINIMAL ACCESS SURGERY
Ahead of Print

Fluorescent ureterography with indocyanine green in laparoscopic colorectal surgery: A safe method to prevent intraoperative ureteric injury


1 Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
2 Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

Correspondence Address:
Abhijith Acharya,
Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.jmas_183_21

Intraoperative injuries to the ureter can occur in complicated colorectal and gynaecologic procedures in minimal access surgery. The majority of these go unrecognised at the time of the operation, which can be disastrous to the patient. The routine use of ureteric stents is controversial, with some studies showing that stents only enable detection of ureteric injury but do not prevent it. Fluorescent image-guided surgery with indocyanine green (ICG) to visualise the ureter is a relatively new technique. We report our method of visualisation of the ureter in two patients undergoing laparoscopic anterior resection and Hartmann procedure, respectively. After induction of anaesthesia, retrograde catheterisation of both ureters was performed by the urologist. 2.5 mg ICG was injected into each catheter at the start of the procedure. Both ureters were visualised very well throughout the procedure with no post-operative complications. This technique using ICG adds visual cues to make up for the loss of tactile feedback, making it a safe strategy to prevent intraoperative ureteric injury.


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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04