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Real-time ureteral identification with novel, versatile, and inexpensive catheter

  • 2019 EAES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although ureteral catheters and ureteral fluorescence methods have been investigated to avoid ureteral injury, they have not been standardized for procedural complexity and safety to the living body. A near-infrared (NIR) fluorescence ureteral catheter made of fluorescent resin was jointly developed for non-invasive detection of ureters. The aims of this study were to (1) evaluate its bench-top performance and (2) assert its safety and potential usefulness in a series of animal models.

Methods

[Bench-top study]: Confirmed stimulation of NIR fluorescence catheter by NIR light was investigated with the use of a laparoscopic fluorescence imaging system. Additionally, the influence of imaging distance and shielding objects, such as 1.5-mm sliced pig loin with multiple sheets, was also evaluated. [Performance study]: The safety and potential usefulness of fluorescence catheter was evaluated in five pigs. Non-fluorescence and fluorescence ureteral catheters were alternatively placed in the animals’ left and right ureters. The ImageJ software was used in all experiments to quantify fluorescence signal and the signal-to-background ratio.

Results

[Bench-top study]: The fluorescence ureteral catheter was successfully identified at all distances. Its fluorescence decreased in inverse proportion to distance and to the intervening shield thickness (p  < 0.01). When shields were present, catheter position could not be recognized with non-fluorescence catheters, but with fluorescence catheters they could be recognized. [Performance study]: Fluorescence catheter’s ability to fluoresce at all distances was confirmed (p  < 0.01). No individual differences (p = 0.21) or left/right ureter differences (p  = 0.79) were observed. The fluorescence of the fluorescence catheter decreased in inverse proportion to distance (p  < 0.01).

Conclusions

The new fluorescence ureter catheter investigated shows promising performance in providing ureteral identification with high specificity during laparoscopic surgery.

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References

  1. Harkki-Siren P, Sjoberg J, Makinen J, Heinonen PK, Kauko M, Tomas E, Laatikainen T (1997) Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations. Am J Obstet Gynecol 176:118–122

    Article  CAS  Google Scholar 

  2. Datta S, Wheatstone S, Challacombe B (2013) The acute management of iatrogenic urological injuries; strategies and mind-set for the urologist attending an unfamiliar operating theatre. BJU Int 112:540–542

    Article  Google Scholar 

  3. Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2014) Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 57:179–186

    Article  Google Scholar 

  4. Brandes S, Coburn M, Armenakas N, McAninch J (2004) Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 94:277–289

    Article  Google Scholar 

  5. Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N (2012) EAU guidelines on iatrogenic trauma. Eur Urol 62:628–639

    Article  Google Scholar 

  6. Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM (2012) Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg 147:267–271

    Article  Google Scholar 

  7. Andersen P, Andersen LM, Iversen LH (2015) Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc 29:1406–1412

    Article  Google Scholar 

  8. Kiran A, Hilton P, Cromwell D (2016) The risk of ureteric injury associated with hysterectomy: a 10-year retrospective cohort study. BJOG 123(7):1184–1191

    Article  CAS  Google Scholar 

  9. Hairston JC, Ghoniem G (2003) Urinary tract injuries: recognition And management. Clin Colon Rectal Surg 16(1):027–038

    Article  Google Scholar 

  10. Senagore AJ, Luchtefeld M (1994) An initial experience with lighted ureteral catheters during laparoscopic colectomy. J Laparoendosc Surg 4:399–403

    Article  CAS  Google Scholar 

  11. Blackwell RH, Kirshenbaum EJ, Shah AS, Kuo PC, Gupta GN, Turk TMT (2018) Complications of recognized and unrecognized Iatrogenic ureteral injury at time of hysterectomy: a population based analysis. J Urol 199:1540–1545

    Article  Google Scholar 

  12. Coakley KM, Kasten KR, Sims SM, Prasad T, Heniford BT, Davis BR (2018) Prophylactic ureteral catheters for colectomy: a National surgical quality improvement program-based analysis. Dis Colon Rectum 61:84–88

    Article  Google Scholar 

  13. da Silva G, Boutros M, Wexner SD (2012) Role of prophylactic ureteric stents in colorectal surgery. Asian J Endosc Surg 5:105–110

    Article  Google Scholar 

  14. Chahin F, Dwivedi AJ, Paramesh A, Chau W, Agrawal S, Chahin C, Kumar A, Tootla A, Tootla F, Silva YJ (2002) The implications of lighted ureteral stenting in laparoscopic colectomy. JSLS 6:49–52

    PubMed  PubMed Central  Google Scholar 

  15. Kaku S, Shimizu Y, Wakinoue S, Takebayashi A, Takashima A, Tarumoto Y, Nakagawa T, Kita N, Takahashi K, Murakami T (2010) Prevention of ureteral damage by using ureteral illuminating catheter during laparoscopic surgery. Jpn J Gynecol Obstet Endosc 26:541–544

    Article  Google Scholar 

  16. Ushimaru Y, Omori T, Fujiwara Y, Yanagimoto Y, Sugimura K, Yamamoto K, Moon JH, Miyata H, Ohue M, Yano M (2018) The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 23(3):468–476

    Article  Google Scholar 

  17. Matsui A, Tanaka E, Choi HS, Kianzad V, Gioux S, Lomnes SJ, Frangioni JV (2010) Real-time, near-infrared, fluorescence-guided identification of the ureters using methylene blue. Surgery 148:78–86

    Article  Google Scholar 

  18. Schols RM, Lodewick TM, Bouvy ND, van Dam GM, Dejong CH, Stassen LP (2014) Application of a new dye for near-infrared fluorescence laparoscopy of the ureters: demonstration in a pig model. Dis Colon Rectum 57:407–411

    Article  Google Scholar 

  19. Al-Taher M, van den Bos J, Schols RM, Bouvy ND, Stassen LP (2016) Fluorescence ureteral visualization in human laparoscopic colorectal surgery using methylene blue. J Laparoendosc Adv Surg Tech A 26:870–875

    Article  Google Scholar 

  20. Schols RM, Connell NJ, Stassen LP (2015) Near-infrared fluorescence imaging for real-time intraoperative anatomical guidance in minimally invasive surgery: a systematic review of the literature. World J Surg 39:1069–1079

    Article  Google Scholar 

  21. Kono Y, Ishizawa T, Tani K, Harada N, Kaneko J, Saiura A, Bandai Y, Kokudo N (2015) Techniques of fluorescence cholangiography during laparoscopic cholecystectomy for better delineation of the bile duct anatomy. Medicine 94:e1005

    Article  Google Scholar 

  22. Schneider CA, Rasband WS, Eliceiri KW (2012) NIH image to ImageJ: 25 years of image analysis. Nat Methods 9:671–675

    Article  CAS  Google Scholar 

  23. Parpala-Sparman T, Paananen I, Santala M, Ohtonen P, Hellstrom P (2008) Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol 42:422–427

    Article  Google Scholar 

  24. McKinley SK, Brunt LM, Schwaitzberg SD (2014) Prevention of bile duct injury: the case for incorporating educational theories of expertise. Surg Endosc 28:3385–3391

    Article  Google Scholar 

  25. Shallaly GEI, Cuschieri A (2000) Nature, aetiology and outcome of bile duct injuries after laparoscopic cholecystectomy. HPB 2:3–12

    Article  Google Scholar 

  26. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

    CAS  PubMed  Google Scholar 

  27. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237:460–469

    PubMed  PubMed Central  Google Scholar 

  28. Merola J, Arnold B, Luks V, Ibarra C, Resio B, Davis KA, Pei KY (2018) Prophylactic ureteral stent placement vs no ureteral stent placement during open colectomy. JAMA Surg 153:87–90

    Article  Google Scholar 

  29. Chu W, Chennamsetty A, Toroussian R, Lau C (2017) Anaphylactic shock after intravenous administration of indocyanine green during robotic partial nephrectomy. Urol Case Rep 12:37–38

    Article  Google Scholar 

  30. Ginimuge PR, Jyothi SD (2010) Methylene blue: revisited. J Anaesthesiol Clin Pharmacol 26:517–520

    PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This work was presented and prized at the Gerhard Buess Technology Award session during the 27th International EAES Congress, Sevilla, Spain, held on June 13 and 14, 2019.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Next Generation Endoscopic Intervention (Project ENGINE), Center of Medical Innovation and Translational Research, Osaka University Graduate School of Medicine, Suite 0912, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yuki Ushimaru & Kiyokazu Nakajima

  2. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yuki Ushimaru, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Yuichiro Doki & Kiyokazu Nakajima

  3. Research and Development, Cardinal Health Japan, Tokyo, Japan

    Atsushi Ohigawa

  4. Department of Surgery and Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan

    Masaki Mori

Authors
  1. Yuki Ushimaru
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  2. Atsushi Ohigawa
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  3. Kotaro Yamashita
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  8. Yukinori Kurokawa
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  9. Makoto Yamasaki
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  11. Yuichiro Doki
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  12. Kiyokazu Nakajima
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Corresponding author

Correspondence to Kiyokazu Nakajima.

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Disclosures

Dr. Yuki Ushimaru, Mr. Atsushi Ohigawa, Dr. Kotaro Yamashita, Dr. Takuro Saito, Dr. Koji Tanaka, Dr. Tomoki Makino, Dr. Tsuyoshi Takahashi, Dr. Yukinori Kurokawa, Dr. Makoto Yamasaki, Dr. Masaki Mori, Dr. Yuichiro Doki, and Dr. Kiyokazu Nakajima have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures in this study were performed in accordance with the ethical standards of the responsible committee on institutional human experimentation and with the Helsinki Declaration of 1964 and its later versions.

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Ushimaru, Y., Ohigawa, A., Yamashita, K. et al. Real-time ureteral identification with novel, versatile, and inexpensive catheter. Surg Endosc 34, 3669–3678 (2020). https://doi.org/10.1007/s00464-019-07261-4

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  • DOI: https://doi.org/10.1007/s00464-019-07261-4

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