S. B. Bryczkowski1, J. E. Glanville2, A. H. Khosravi3, A. S. Rosenstock1, G. Mazpule1, S. G. Pereira1 1Hackensack University Medical Center,Surgery,Hackensack, NJ, USA 2Hospital Corporation of America,Surgery,Richmond, VA, USA 3St. Joseph Hospital,Surgery,Tustin, CA, USA
Introduction: Robotic surgery has gained favor across specialties. There is an ongoing effort to make colorectal surgery safer. Urologists have used indocyanine green (ICG) dye to identify ureters during robotic ureterolysis, but no studies existed on ICG use during robotic colectomy. We hypothesized that intraureteral ICG would decrease the time to identify the ureters during robotic sigmoid colectomy.
Methods: A retrospective review of prospective data at a single academic center. The use of ICG for ureteral identification reflected a change in practice. Patients either had ureteral stents with intraureteral ICG or stents alone (no ICG). Colectomies were performed by one of three attending surgeons and assisted by one of three robotic fellows. The primary outcomes were time to identify ureters and operative (OR) time. Secondary outcomes were complications of ureteral injury, leak, and infection. All adults (>18) who presented for elective robotic sigmoid colectomy between Oct ’15 – Aug ‘17 were included. Exclusion criteria were pregnancy, age ≤18, and emergency surgery. Data collection included demographics (age, gender), surgical indication (complicated or recurrent diverticulitis or neoplasm), and clinical data (number (n) diverticulitis episodes, n previous surgeries). Data were analyzed using student t test, chi square analysis, or one-way ANOVA.
Results: Of 151 patients admitted for colectomy, 30 met criteria. Of those, 16 received ICG and 14 did not (no ICG). There were no differences in age between ICG and no ICG, [presented as mean (m), ± standard deviation (sd)] (59 ± 15 vs. 63 ± 10, p=0.21) or gender, [% female] (50% vs. 71%, p=0.23). There was a statistically significant decrease in the time to identify the ureters in the ICG group [m ± sd] (10min ± 12 vs. 38 ± 81, p=0.04). There were no differences in OR time (264min ± 63 vs. 281 ± 52, p=0.11), n diverticulitis episodes (4 ± 3 vs. 5 ± 9, p=0.39), n previous abdominal surgeries (0.9 ± 0.8 vs. 0.5 ± 0.8, p=0.06), cases of complicated diverticulitis, [n, %] (6, 38% vs. 6, 43%, p=0.76), or in rate of ureteral identification (16, 100% vs. 13, 93%, p=0.14).
Conclusion: This single center study demonstrated that intraureteral ICG allowed faster ureteral identification during robotic sigmoid colectomy. Although overall OR time did not differ between the groups, all ureters were identified when ICG was used. Early ureteral identification with ICG could lead to safer colorectal surgery by preventing injury to the ureters. Future studies should focus on whether early ureteral identification using ICG leads to decreased incidence of ureteral injury during robotic colectomy.
