AB007. SOH25_AB_307. Ureteric safeguarding in colorectal resection with indocyanine green visualisation: a video vignette

Background: Ureteric identification and safeguarding is essential in abdominopelvic surgeries when Gerota’s fascia and the retroperitoneum are encountered, especially in cases with inflammation or prior surgical intervention. Clear and unambiguous ureteric visualisation can assist operators of all levels of experience, ensuring safe and efficient dissection.

Methods: Our video demonstrates the use of synchronous near-infrared (NIR)/red, green, blue (RGB) ureteric visualisation using indocyanine green (ICG) instillation in a male patient undergoing laparoscopic sigmoidectomy for chronic diverticular phlegmon with synchronous colovesical, enterovesical, and colorectal fistulae. The patient presented with a two-year history of abdominal pain, weight loss, and faecaluria following an initial presentation when imaging demonstrated a diverticular abscess that was conservatively managed. Follow-up radiological imaging, cystoscopy, and colonoscopy revealed complex fistulating disease.

Results: With preoperative counselling, we proceeded to a laparoscopic sigmoidectomy using the latest generation Stryker 1788 platform (Stryker Corporation, USA) which synchronises high-definition white light and NIR imagery. To enable this NIR ureteric visualisation, ureteric catheters were placed cystoscopically and instilled with ICG with the patient under anaesthesia but before laparoscopy commencement. This allowed for continuous visualisation of the ureters during the operation enabling safe, efficient dissection with reduced cognitive work for the team. Additionally, ICG assessment was used to assess perfusion of the bowel transection points using the same imaging system.

Conclusions: We anticipate that with future availability of renally-excreted fluorescent agents, the practice of intrinsic ureteric delineation will become gold standard, providing unequivocal ureteric identification, potentially reducing the rate of operative complications in challenging operations.

Keywords: Indocyanine green (ICG); laparoscopic; near-infrared (NIR); real-time visualization; ureteral identification