Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: Urethral injury is a complication feared by surgeons performing transanal TME (TaTME) or abdominoperineal excision (APE) procedures. Injury during TaTME occurs when the prostate is inadvertently mobilised or as a direct injury similar to the direct injury during the perineal dissection of APE procedures. We performed a proof of principle study to assess the feasibility of using indocyanine green (ICG) to fluoresce the urethra in human cadavers. METHODS: Indocyanine green at varying doses was mixed with Instillagel and infiltrated into the urethra of male human cadavers. The urethra was exposed through either a perineal incision or by mobilisation of the prostate during a TaTME dissection and fluorescence observed using a PINPOINT laparoscope (NOVADAQ). Brightness was assessed on the images using ImageJ (National Institute of Health). RESULTS: Eight cadavers were included in the study. Fluorescence was visualised in the urethra in all eight cadavers. Minimal dissection was required to obtain fluorescence transperineally. In one cadaver, the urethra was demonstrated under fluorescence using a simulated TaTME with additional fluorescence also being observed in the prostate. There was no correlation between brightness and dosing. CONCLUSIONS: This novel proof of principle study demonstrates a simple way in which the urethra may be easily identified preventing it from injury during surgery.

Original publication

DOI

10.1007/s10151-017-1615-y

Type

Journal article

Journal

Tech coloproctol

Publication Date

06/2017

Volume

21

Pages

439 - 444

Keywords

Colorectal surgery, Fluorescence, Laparoscopic surgery, Rectal cancer, Urethra, Urethral injury, Cadaver, Coloring Agents, Dissection, Feasibility Studies, Humans, Indocyanine Green, Intraoperative Care, Male, Optical Imaging, Perineum, Postoperative Complications, Prostate, Transanal Endoscopic Surgery, Urethra