Presentation Authors: Nariman Ahmadi*, Natalie Hartman, Akbar Ashrafi, Aliasger Shekir, Giovanni Cacciamani, Daniel Frietas, Andre Berger, Mihir Desai, Inderbir Gill, Monish Aron, Los Angeles, CA
Introduction: We evaluated the impact of Indocyanine green (ICG) for assessment of ureteral vascularity on the rate of stricture formation after robotic-assisted radical cystectomy (RRC) with intra-corporeal urinary diversion (ICUD).
Methods: We identified 179 patients undergoing RRC and ICUD between January 2014 and May 2017 and divided the patients into two groups based on the utilization of ICG for assessment of ureteral vascularity (non-ICG group and ICG group). We retrospectively reviewed the medical records to identify the length of ureter excised. Demographic, perioperative outcomes including 90-day complications and readmissions, and the rate of ureteroenteric stricture were compared between two groups. The two groups were compared using the t-test for continuous variables and the chi-squared test for categorical variables. A p-value < 0.05 was considered statistically significant.
Results: A total of 132 and 47 patients were in the non-ICG group and the ICG group respectively. There were no differences in baseline characteristics and perioperative outcomes including operating time, estimated blood loss and length of stay. The ICG group was associated with a greater length of ureter being excised during the uretero-enteric anastomosis and a greater proportion of patients having long segment (>5cm) ureteral resection. The median follow-up was 14 and 12 months in the non-ICG and ICG groups, respectively. The ICG group was associated with no uretero-enteric strictures compared to a per-patient stricture rate of 10.6% and a per-ureter stricture rate of 6.6% in the non-ICG group (p=0.020 and p=0.013, respectively).
Conclusions: The use of ICG fluorescence to assess distal ureteral vascularity during RRC and ICUD can reduce the risk of ischemic uretero-enteric strictures. The technique is simple, safe and reproducible. Larger studies are needed to confirm these findings.