title: Novel use of indocyanine green for intraoperative, real-time localization of ureteral stenosis during robot-assisted ureteroureterostomy.
abstract: OBJECTIVE
  To present a novel method to intraoperatively localize ureteral strictures during robot-assisted ureteroureterostomy via indocyanine green (ICG) visualization under near-infrared (NIR) light.
  
  
  METHODS
  Seven patients underwent robot-assisted ureteroureterostomy for ureteral stricture by a single surgeon (D.D.E.). Intraoperative localization of ureteral stricture involved instilling ICG (25 mg in 10 mL distilled water) above and below the level of stenosis through a ureteral catheter or a percutaneous nephrostomy tube, or both. The fluorescent tracer was detected as a green color using the NIR modality on the da Vinci Si (Intuitive Surgical, Sunnyvale, CA). All patients consented to off-label use of ICG after full disclosure.
  
  
  RESULTS
  Intraoperative ICG injection and visualization under NIR light assisted in the performance of a tension-free anastomosis in all patients. At the time of surgery, mean age was 55.7 ± 12.4 years and mean body mass index was 30.3 ± 5.8 kg/m(2). Mean operative time was 171.3 ± 52.4 minutes, mean estimated blood loss was 175.0 ± 146.5 mL, and mean length of ureteral excision on pathologic analysis was 1.6 ± 0.7 cm. There were no immediate or delayed adverse effects attributable to intraureteral ICG administration. Mean hospital length of stay was 1.6 ± 1.5 days, with no postoperative complications. Mean follow-up was 5.9 ± 1.5 months, and all cases were clinically and radiographically successful at last follow-up.
  
  
  CONCLUSIONS
  Intraureteral injection of ICG with visualization under NIR light allows for real-time delineation of the ureter. Additionally, ICG administration aids in discerning healthy ureter from diseased tissue, further assisting successful robotic ureteral repair.
authors.affiliation: Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Ziho
authors.initials: Z
authors.lastname: Lee
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Parker
authors.forename: Christopher
authors.initials: C
authors.lastname: Reilly
authors.forename: Elton
authors.initials: E
authors.lastname: Llukani
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Jack H
authors.initials: JH
authors.lastname: Mydlo
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Eun
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012371:Robotics; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green