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Journal article

Fluorescence to highlight the urethra - a human cadaveric study

Abstract:

Purpose: Urethral injury is a feared complication of surgeons performing transanal TME (TaTME) or abdomino-perineal 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. This is a proof-in-principle study aiming to assess the feasibility of using 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 8 cadavers. Minimal dissection was required to obtain fluorescence trans-perineally. 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.

Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1007/s10151-017-1615-y

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Surgical Sciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Surgical Sciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Surgical Sciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Surgical Sciences
Role:
Author


Publisher:
Spinger Verlag
Journal:
Techniques in Coloproctology More from this journal
Volume:
21
Issue:
6
Pages:
439-444
Publication date:
2017-05-30
Acceptance date:
2017-02-27
DOI:
EISSN:
1128-045X
ISSN:
1123-6337


Keywords:
Pubs id:
pubs:686459
UUID:
uuid:d90a89dd-35fb-4c57-a7c3-07c707513b6e
Local pid:
pubs:686459
Source identifiers:
686459
Deposit date:
2017-03-21

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