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Khojah B, Enani G, Saleem A, Malibary N, Sabbagh A, Malibari A, Alhalabi W. Deep learning-based intraoperative visual guidance model for ureter identification in laparoscopic sigmoidectomy. Surg Endosc 2025; 39:3610-3623. [PMID: 40263136 DOI: 10.1007/s00464-025-11694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 03/30/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Identifying the left ureter is a key step while performing laparoscopic sigmoid resection to prevent intraoperative injury and postoperative complications. METHODS This feasibility study aims to evaluate the real-time performance of a deep learning-based computer vision model in identifying the left ureter during laparoscopic sigmoid resection. A deep learning model for ureteral identification was developed using a semantic segmentation algorithm trained from intraoperative images of ureteral dissection in videos depicted from laparoscopic sigmoid resection. We used 86 laparoscopic sigmoid resection recordings performed at King Abdulaziz University Hospital (KAUH), which were further processed with manual annotation. A total of 1237 images were extracted and annotated by three colorectal surgeons. Deep learning You Only Look Once (YOLO) versions 8 and 11 models were applied to the video recording of ureteral identification. Per-frame five-fold cross-validation was used to evaluate model performance. RESULTS Experiments showed high results with a mean Average Precision (mAP50) of 0.92 for the Intersection over Union (IoU) threshold greater than or equal to 0.5. The precision, recall, and Dice Coefficient (DC) evaluation metrics are 0.94, 0.88, and 0.90, respectively. The highest DC result is 0.95, achieved through the fourth-fold cross-validation. The stricter IoU threshold between 0.5 and 0.95 is represented by mAP50-95, which is 0.53. The model operated at a speed of 32 Frames Per Second (FPS), indicating it can work in real-time. CONCLUSION Deep learning YOLO 8 and 10 for semantic segmentation demonstrates accurate real-time identification of the left ureter in selected videos. A deep learning model could be used to project high-accuracy identification of real-time left ureter during laparoscopic sigmoidectomy using surgeons' expertise in intraoperative image navigation. Limitations included the sample size, lack of diversity in the methods of surgery, incomplete surgical processes, and lack of external validation.
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Affiliation(s)
| | - Ghada Enani
- King Abdulaziz University, Jeddah, Saudi Arabia
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Penza V, Soriero D, Sperotto B, Neri A, Ortiz J, Pertile D, Epis L, Carganico G, Amisano M, Scabini S, Caldwell DG, Mattos LS. Evaluating the EVA surgical navigation system for ureteral identification in an in vivo porcine model. Sci Rep 2025; 15:16976. [PMID: 40374683 PMCID: PMC12081927 DOI: 10.1038/s41598-025-00138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Accepted: 04/25/2025] [Indexed: 05/17/2025] Open
Abstract
Surgical safety has emerged as a significant public health concern. Ureteral injury (UI) is one of the most common forms of iatrogenic urological issues, lacking non-invasive prevention strategies. In this context, computer-assisted technologies offer a promising solution for enhancing intra-operative safety. This paper presents an in-vivo study focused on evaluating the feasibility of using an augmented reality (AR) surgical navigation system (EVA) for intra-operative ureteral identification on an animal model. An experienced surgeon performed a technical assessment of the system. The clinical evaluation was conducted by four general surgeons tasked with identifying the left or right ureter, both with and without EVA. The technical assessment highlighted that EVA is easily integrable with operating room instruments, achieving a calibration accuracy of [Formula: see text], and the virtual ureter effectively overlapping with the real ureter. The questionnaires indicated that surgeons appreciated EVA, with a [Formula: see text]. The perceived mental demand, task complexity, and distractions were lower when using the EVA system. Future work will focus on increasing the number of subjects and exploring the efficacy of the system on other clinical tasks.
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Affiliation(s)
- Veronica Penza
- Advanced Robotics, Istituto Italiano di Tecnologia, 16163, Genoa, Italy.
| | - Domenico Soriero
- Chirurgia Oncologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | | | - Alberto Neri
- Advanced Robotics, Istituto Italiano di Tecnologia, 16163, Genoa, Italy
- Department of Computer Science, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, 16145, Genoa, Italy
| | - Jesus Ortiz
- Advanced Robotics, Istituto Italiano di Tecnologia, 16163, Genoa, Italy
| | - Davide Pertile
- Chirurgia Oncologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | | | | | - Marco Amisano
- Chirurgia Oncologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Stefano Scabini
- Chirurgia Oncologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Darwin G Caldwell
- Advanced Robotics, Istituto Italiano di Tecnologia, 16163, Genoa, Italy
| | - Leonardo S Mattos
- Advanced Robotics, Istituto Italiano di Tecnologia, 16163, Genoa, Italy
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Pompeu BF, de Arruda Ribeiro CT, Pasqualotto E, Delgado LM, de Souza Pinto Guedes LS, de Figueiredo SMP, Borges L, Formiga FB. Prophylactic ureteral stent in colorectal surgery: a meta-analysis and systematic review. Int Urol Nephrol 2025; 57:301-312. [PMID: 39379754 DOI: 10.1007/s11255-024-04224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 09/28/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury. METHODS We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1. RESULTS Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I2 = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I2 = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I2 = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I2 = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation. CONCLUSION In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.
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Affiliation(s)
- Bernardo Fontel Pompeu
- Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil.
- Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil.
- University of São Caetano do Sul - USCS, São Caetano do Sul, Brazil.
| | | | | | | | | | | | - Leonardo Borges
- Department of Urology, Albert Einstein Hospital, São Paulo, Brazil
| | - Fernanda Bellotti Formiga
- Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil
- Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil
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Zhang Y, Peng S, Guo J, Li J, Lu Z, Wu T, Chen L, Liu W, Feng Z, Zhang M, Qian J. High-Definition, Video-Rate Triple-Channel NIR-II Imaging Using Shadowless Lamp Excitation and Illumination. ACS NANO 2025; 19:1743-1756. [PMID: 39749993 DOI: 10.1021/acsnano.4c15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Multichannel imaging in the second near-infrared (NIR-II) window offers vital and comprehensive information for complex surgical environments, yet a simple, high-quality, video-rate multichannel imaging method with low safety risk remains to be proposed. Centered at the superior NIR-IIx window of 1400-1500 nm, triple-channel imaging coordinated with 1000-1100 and 1700-1880 nm (NIR-IIc) achieves exceptional clarity and an impressive signal-to-crosstalk ratio as high as 22.10. To further simplify the light source and lower the safety risk, we develop a type of in vivo multichannel imaging-assisted surgical navigation mode at a video frame rate of 25 fps under shadowless lamp excitation and illumination instead of extra excitation light sources. This work provides a reference for real-time, high-imaging-performance multichannel imaging with minimal crosstalk and introduces a practical fluorescence surgical navigation paradigm.
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Affiliation(s)
- Yuhuang Zhang
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Shiyi Peng
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Jian Guo
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
| | - Jiayi Li
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Zeyi Lu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Tianxiang Wu
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Liying Chen
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Wen Liu
- College of Physics and Electronic Information Engineering, Zhejiang Normal University, Jinhua 321004, China
| | - Zhe Feng
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
| | - Mingxi Zhang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
| | - Jun Qian
- State Key Laboratory of Extreme Photonics and Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, International Research Center for Advanced Photonics, Zhejiang University, Hangzhou 310058, China
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Lin CS, Lee JR, Chiu KY, Wang SS, Chen CS, Lin YJ, Che CC. Predictors of Failed Outcomes in Ureteral Reconstruction: A Real-World Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1672. [PMID: 39459459 PMCID: PMC11509605 DOI: 10.3390/medicina60101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 09/25/2024] [Accepted: 10/10/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: Ureteral reconstruction is aimed at maintaining ureteral patency without the need for long-term catheters like ureteral stents or percutaneous nephrostomies. Different surgical strategies are adopted based on the etiology, the location of the injury, and the severity of the injury. We aimed to analyze the parameters that can predict which patients might not be free from further catheterization after reconstruction. Materials and Methods: This study included patients who underwent ureteral reconstruction from January 2007 to December 2021. The success of ureteral reconstruction was defined as being free from further catheterization after the operation. Results: A total of 184 patients underwent ureteral reconstruction. Malignant disease with ureteral invasion and iatrogenic injuries accounted for 79.9% of the cases. The majority (79.3%) did not have to undergo subsequent interventions. Predictors for a failed result of ureteral reconstruction included a history of radiotherapy (OR = 2.75, p = 0.01), chronic kidney disease (CKD) (OR = 3.42, p < 0.001), and an upper ureteric location of the injury (OR = 5.68, p = 0.042). Conclusions: A history of radiation therapy, an upper third ureteric location of the injury, and CKD were identified as predictors of a failed ureteral reconstruction. Malignant diseases, surgical methods, and repair techniques did not significantly affect the outcome of the operation.
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Affiliation(s)
- Ching-Shiang Lin
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Jian-Ri Lee
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-R.L.); (K.-Y.C.); (S.-S.W.); (C.-S.C.)
| | - Kun-Yuan Chiu
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-R.L.); (K.-Y.C.); (S.-S.W.); (C.-S.C.)
| | - Shian-Shiang Wang
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-R.L.); (K.-Y.C.); (S.-S.W.); (C.-S.C.)
| | - Chuan-Shu Chen
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-R.L.); (K.-Y.C.); (S.-S.W.); (C.-S.C.)
| | - Yu-Ju Lin
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chen-Cheng Che
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-R.L.); (K.-Y.C.); (S.-S.W.); (C.-S.C.)
- Department of Medicine and Nursing, Hungkuang University, Taichung 43304, Taiwan
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McClelland PH, Liu T, Johnson RP, Glenn C, Ozuner G. Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort. Tech Coloproctol 2024; 28:137. [PMID: 39361072 DOI: 10.1007/s10151-024-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/30/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures. METHODS Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI. RESULTS Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI. CONCLUSIONS While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.
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Affiliation(s)
- P H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
| | - T Liu
- Division of Colorectal Surgery, Baylor St. Luke's Medical Group, The Woodlands, TX, USA
| | - R P Johnson
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - C Glenn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Ozuner
- Department of Colorectal Surgery, Arnot Ogden Medical Center, Elmira, NY, USA
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Ryu S, Imaizumi Y, Nakashima S, Kawakubo H, Kawai H, Kobayashi T, Ito R, Nakabayashi Y. Utility and challenges of ureteral visualization using a fluorescent ureteral catheter in high risk surgeries for colorectal cancer. Surg Endosc 2024; 38:6184-6192. [PMID: 39266754 DOI: 10.1007/s00464-024-11211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Ureteral injury occurs in 0.3-1.5% of colorectal cancer surgeries. Devices to visualize the ureteral course and avoid ureteral injury are required for minimally invasive surgery (MIS). The NIRC™ fluorescent ureteral catheter (FUC) is a versatile ureteral visualization device currently available in Japan that can be used in combination with a variety of laparoscopic and robotic systems. In this study, we examined the outcomes of high-risk patients who underwent colorectal cancer surgery with FUC insertion. METHODS One hundred forty-one patients who underwent MIS for colorectal cancer and colorectal cancer recurrence at our institute between January 2021 and May 2024 underwent preoperative FUC insertion because of the high risk of ureteral injury and surgical difficulty. For these patients, patient background data and short-term outcomes were examined. The results are expressed as the median and interquartile range. RESULTS Age, 70 [60-78]; M:F(n), 84:57; BMI, 22.1 [19.7-24.7]; T4 (TNM classification), 52 cases (36.9%); preoperative intestinal obstruction, 45 cases (31.9%); abscess formation, 30 cases (21%); surgical history, 70 cases (50%); recurrent cancer, 14 cases (9.9%); preoperative chemo-radiotherapy, 28 cases (19.9%); time required for FUC insertion, 12 [9-19] minutes; operation time, 412 [309-552] minutes; blood loss, 10 [5-30] ml; open conversion, 0 cases; postoperative hospitalization, 12 [9-17.5]; circumferential resection margins < 1 mm (rectal surgery), 4/87 cases (4.6%); comorbidities, 0 ureteral injury, 1 urethral injury during FUC insertion (0.7%) and 16 CD Grade 3 or higher cases (11%). CONCLUSIONS FUC may improve the safety of MIS and reduce blood loss in addition to preventing ureteral injury and is expected to have oncological advantages for ensuring the margin of the tumor without fear of ureteral injury. However, the time required for and complications associated with FUC are challenging. New methods for less invasive and easier ureteral visualization may be needed.
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Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Yuta Imaizumi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Shunsuke Nakashima
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Hyuga Kawakubo
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Hironari Kawai
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Takehiro Kobayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
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Hasnaoui A, Trigui R, Dhahak AG, Nouira M, Gargouri M, Ganzoui I. Iatrogenic ureteral injury diagnosed after colon cancer surgery: A case report of a rare and challenging complication. Int J Surg Case Rep 2024; 122:110147. [PMID: 39126930 PMCID: PMC11367097 DOI: 10.1016/j.ijscr.2024.110147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Iatrogenic ureteral injury (IUI) is an unfortunate and rare complication during colorectal surgery. While IUI remains a rare event, short and long-term complications are life-threatening ranging from intraperitoneal urinoma to septic shock and a serious risk of permanent renal failure. CASE PRESENTATION An 88-year-old patient was admitted with symptoms of large bowel obstruction and underwent a laparotomy with a discharge colostomy. A week later, a second laparotomy was required for a non-functional retracted stoma, revealing a perforation in a sigmoid tumor. The patient then had an oncological sigmoidectomy with Hartman's colostomy. Postoperative findings indicated a left ureteral injury. Three weeks later, a ureterostomy was performed. Unfortunately, the patient succumbed to heart failure one week after the ureterostomy. DISCUSSION Low anterior and abdominoperineal resection of the rectum, along with sigmoid resection are the most frequent causes of ureteral injury in digestive surgery. The primary objective of management is to establish a continuous flow of urine to avert potential complications. Preventing IUI in colorectal surgery is of paramount importance. This process initiates in the preoperative phase with a meticulous assessment of ureteral and colic anatomy through comprehensive review of preoperative imaging. CONCLUSION IUI remains a seldom-seen, and yet a very serious complication in colorectal surgery. It is imperative to prioritize both preoperative and intraoperative measures to prevent IUI, ensuring optimal outcomes. When the diagnosis of a IUI is established, a treatment strategy should be meticulously devised and executed by a skilled and experienced surgeon.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Ahmed Ghaieth Dhahak
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of radiology, Habib Bougatfa hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Mariem Nouira
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of epidemiology, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Mourad Gargouri
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of Urology, Habib Bougatfa hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Imen Ganzoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of radiology, Habib Bougatfa hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
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Rogers P, Dourado J, Wignakumar A, Weiss B, Aeshbacher P, Garoufalia Z, Strassmann V, Emile S, Strzempek P, Wexner S. The role of ureteric indocyanine green fluorescence in colorectal surgery: a retrospective cohort study. Tech Coloproctol 2024; 28:83. [PMID: 38985353 PMCID: PMC11236861 DOI: 10.1007/s10151-024-02955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/08/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Ureteric injury (UI) is an infrequent but serious complication of colorectal surgery. Prophylactic ureteric stenting is employed to avoid UI, yet its efficacy remains debated. Intraoperative indocyanine green fluorescence imaging (ICG-FI) has been used to facilitate ureter detection. This study aimed to investigate the role of ICG-FI in identification of ureters during colorectal surgery and its impact on the incidence of UI. METHODS A retrospective cohort study involving 556 consecutive patients who underwent colorectal surgery between 2018 and 2023 assessed the utility of routine prophylactic ureteric stenting with adjunctive ICG-FI. Patients with ICG-FI were compared to those without ICG-FI. Demographic data, operative details, and postoperative morbidity were analyzed. Statistical analysis included univariable regression. RESULTS Ureteric ICG-FI was used in 312 (56.1%) patients, whereas 43.9% were controls. Both groups were comparable in terms of demographics except for a higher prevalence of prior abdominal surgeries in the ICG-FI group. Although intraoperative visualization was significantly higher in the ICG-FI group (95.3% vs 89.1%; p = 0.011), the incidence of UI was similar between groups (0.3% vs 0.8%; p = 0.585). Postoperative complications were similar between the two groups. Median stent insertion time was longer in the ICG-FI group (32 vs 25 min; p = 0.001). CONCLUSION Ureteric ICG-FI improved intraoperative visualization of the ureters but was not associated with a reduced UI rate. Median stent insertion time increased with use of ureteric ICG-FI, but total operative time did not. Despite its limitations, this study is the largest of its kind suggesting that ureteric ICG-FI may be a valuable adjunct to facilitate ureteric visualization during colorectal surgery.
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Affiliation(s)
- P Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - J Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - A Wignakumar
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - B Weiss
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - P Aeshbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - V Strassmann
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - S Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - P Strzempek
- Ross University School of Medicine, Miramar, USA
| | - S Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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10
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Morales-Conde S, Navarro-Morales L, Moreno-Suero F, Balla A, Licardie E. Fluorescence and tracers in surgery: the coming future. Cir Esp 2024; 102 Suppl 1:S45-S60. [PMID: 38851317 DOI: 10.1016/j.cireng.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
The revolution that we are seeing in the world of surgery will determine the way we understand surgical approaches in coming years. Since the implementation of minimally invasive surgery, innovations have constantly been developed to allow the laparoscopic approach to go further and be applied to more and more procedures. In recent years, we have been in the middle of another revolutionary era, with robotic surgery, the application of artificial intelligence and image-guided surgery. The latter includes 3D reconstructions for surgical planning, virtual reality, holograms or tracer-guided surgery, where ICG-guided fluorescence has provided a different perspective on surgery. ICG has been used to identify anatomical structures, assess tissue perfusion, and identify tumors or tumor lymphatic drainage. But the most important thing is that this technology has come hand in hand with the potential to develop other types of tracers that will facilitate the identification of tumor cells and ureters, as well as different light beams to identify anatomical structures. These will lead to other types of systems to assess tissue perfusion without the use of tracers, such as hyperspectral imaging. Combined with the upcoming introduction of ICG quantification, these developments represent a real revolution in the surgical world. With the imminent implementation of these technological advances, a review of their clinical application in general surgery is timely, and this review serves that aim.
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Affiliation(s)
- Salvador Morales-Conde
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Laura Navarro-Morales
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Francisco Moreno-Suero
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Andrea Balla
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
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11
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Maheswaran R, Beisland C, Bergesen AK, Almås B. A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity. Sci Rep 2024; 14:13771. [PMID: 38877070 PMCID: PMC11178925 DOI: 10.1038/s41598-024-63847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
This study aimed to register and analyse outcomes after iatrogenic ureteral injuries (IUI) with special emphasis on potential consequences of a delayed diagnosis, and further to analyse if the incidence of IUI has changed during the study period. 108 patients treated for an IUI during 2001-2021 were included. Injuries due to endourological procedures, planned tumour resection and traumatic injuries were excluded. All relevant information to answer the research questions were entered into a database. Chi-square and t-tests were used for categorical and continuous variables respectively. Regression analysis was used to evaluate potential change of incidence in IUIs over time. Our results showed that most IUIs (74, 69%) were caused by gynaecological surgery. 49 (45%) had a delayed diagnosis (not diagnosed intraoperatively). Younger age (mean 50 vs 62 years, p < 0.001) and benign indication for laparoscopic hysterectomy (OR 8.0, p < 0.001) predisposed for a delayed diagnosis. Patients with a delayed diagnosis had a higher number of secondary injury related procedures (mean 4.6 vs 1.7, p < 0.001), hospital admissions (mean 3.0 vs 0.8, p < 0.001) and longer hospital stays (mean 20.6 vs 3.9 days p < 0.001) compared to patients with an intraoperative diagnosis. There was complete recovery for 91% of the patients. We did not observe any changes in IUI incidence during the study period. In conclusion, our study underlines that IUI can cause major morbidity for the patient affected if not diagnosed intraoperatively. Benign indication and younger age are predictors for a delayed diagnosis. The prognosis is good, with 91% full recovery. No significant changes in incidence of IUIs were observed.
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Affiliation(s)
- Rachel Maheswaran
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne K Bergesen
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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12
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Lingam G, Shakir T, Kader R, Chand M. Role of artificial intelligence in colorectal cancer. Artif Intell Gastrointest Endosc 2024; 5:90723. [DOI: 10.37126/aige.v5.i2.90723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/11/2024] Open
Abstract
The sphere of artificial intelligence (AI) is ever expanding. Applications for clinical practice have been emerging over recent years. Although its uptake has been most prominent in endoscopy, this represents only one aspect of holistic patient care. There are a multitude of other potential avenues in which gastrointestinal care may be involved. We aim to review the role of AI in colorectal cancer as a whole. We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer. All trials including qualitative research were included from the year 2000 onwards. Studies were grouped into pre-operative, intra-operative and post-operative aspects. Pre-operatively, the major use is with endoscopic recognition. Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic, Japan Narrow-band Imaging Expert Team, Paris and Kudo. However, novel detection and diagnostic methods have arisen from advances in AI classification. Intra-operatively, adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes. Post-operatively, monitoring and surveillance have taken strides with potential socioeconomic and environmental savings. The uses of AI within the umbrella of colorectal surgery are multiple. We have identified existing technologies which are already augmenting cancer care. The future applications are exciting and could at least match, if not surpass human standards.
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Affiliation(s)
- Gita Lingam
- Department of General Surgery, Princess Alexandra Hospital, Harlow CM20 1QX, United Kingdom
| | - Taner Shakir
- Department of Colorectal Surgery, University College London, London W1W 7TY, United Kingdom
| | - Rawen Kader
- Department of Gastroenterology, University College London, University College London Hospitals Nhs Foundation Trust, London W1B, United Kingdom
| | - Manish Chand
- Gastroenterological Intervention Centre, University College London, London W1W 7TS, United Kingdom
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13
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Heimberger M, Stocchi L, Brennan E, Spaulding A, DeLeon M, Merchea A, Dozois E, Colibaseanu D. Can preoperative ureteral stent placement help in the intraoperative identification of iatrogenic ureteral injury? J Gastrointest Surg 2024; 28:903-909. [PMID: 38555016 DOI: 10.1016/j.gassur.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The benefits of prophylactic ureteral stent placement during colorectal surgery remain controversial. This study aimed to determine the incidence of ureteral injury in colorectal operations, assess the complications associated with stent usage, and determine whether their use leads to earlier identification and treatment of injury. METHODS This was a retrospective study of patients undergoing colorectal abdominal operations between 2015 and 2021. Variables were examined for possible association with ureteral stent placement. The primary study endpoint was ureteral injury identified within 30 days postoperatively. RESULTS Of 6481 patients who underwent colorectal surgery, 970 (15%) underwent preoperative ureteral stent placement. The use of stents was significantly associated with a higher American Society of Anesthesiologists classification, wound classification, and longer duration of surgery. A ureteral injury was identified in 28 patients (0.4%). Of these patients, 13 had no stent, and 15 had preoperative stents placed. After propensity matching, stent use was associated with an increased risk of hematuria and urinary tract infection. Ureteral injury was identified intraoperatively in 14 of 28 patients (50.0%) and was not associated with ureteral stent use (P = .45). CONCLUSION Iatrogenic ureteral injury was uncommon, whereas preoperative stent placement was relatively frequent. Earlier recognition of iatrogenic ureteral injury is not an expected advantage of preoperative ureteral stent placement.
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Affiliation(s)
- Mark Heimberger
- Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Luca Stocchi
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States.
| | - Emily Brennan
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Aaron Spaulding
- Department of Health Care Delivery Research, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Michelle DeLeon
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Amit Merchea
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Eric Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, United States
| | - Dorin Colibaseanu
- Department of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida, United States
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14
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Saito M, Kojima T, Komatsu K, Takusagawa S. Population Pharmacokinetic Modeling and Simulation of Pudexacianinium (ASP5354) for Dose Setting of a Phase 2 First-in-Patient Study: A Novel Imaging Agent for Intraoperative Ureter Visualization during Abdominopelvic Surgery. Clin Pharmacol Drug Dev 2024; 13:454-464. [PMID: 38135485 DOI: 10.1002/cpdd.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Pudexacianinium (ASP5354) chloride is an indocyanine green derivative designed to enable enhanced ureter visualization during surgery. The objective of the present analysis was to determine appropriate doses of pudexacianinium for a phase 2, dose-ranging study (NCT04238481). Real-time urine pudexacianinium concentration is considered a good pharmacodynamic surrogate marker, since ureter visualization likely depends on its concentration in the ureter. Using plasma and urine concentrations of pudexacianinium from a phase 1 single-ascending-dose (0.1-24.0 mg) study in healthy participants, a 3-compartment population pharmacokinetic model with a urine output compartment was developed and effectively described the concentration-time profiles. The individual estimated glomerular filtration rates had a significant impact on drug clearance. Simulations suggested that a 1.0 mg intravenous injection would achieve target urine concentrations over 1 μg/mL (determined from previous nonclinical studies) for 3 hours postdose, assuming a urine production rate of 1.0 mL/min. Based on this simulation, doses of 0.3, 1.0, and 3.0 mg were proposed for the phase 2 study. The observed plasma concentrations were generally consistent with model predictions. For urine, although only limited data could be obtained due to the difficulties of spot urine collection from surgical patients, intraoperative ureter visualization was successful at 1.0 and 3.0 mg.
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15
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Brollo PP, Puggioni A, Tumminelli F, Colangelo A, Biddau C, Cherchi V, Bresadola V. Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives. Surg Today 2024; 54:291-309. [PMID: 36593285 DOI: 10.1007/s00595-022-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review aims to provide a critical overview of the most recent literature about IUI prevention techniques in colorectal surgery. We performed a comprehensive and systematic review of studies published from 2000 to 2022 and assessed the use of techniques for ureteral injury prevention and intraoperative localization. 26 publications were included, divided into stent-based (prophylactic/lighted ureteral stent and near-infrared fluorescent ureteral catheter [PUS/LUS/NIRFUC]) and fluorescent dye (FD) groups. Costs, the percentage and number of IUIs detected, reported limitations, complication rates and other outcome points were compared. The IUI incidence rate ranged from 0 to 1.9% (mean 0.5%) and 0 to 1.2% (mean 0.3%) in the PUS/LUS/NIRFUC and FD groups, respectively. The acute kidney injury (AKI) and urinary tact infection (UTI) incidence rate ranged from 0.4 to 32.6% and 0 to 17.3%, respectively, in the PUS/LUS/NIRFUC group and 0-15% and 0-6.3%, respectively, in the FD group. Many other complications were also compared and descriptively analyzed (length-of-stay, mortality, etc.). These techniques appear to be feasible and safe in select patients with a high risk of IUI, but the delineation of reliable guidelines for preventing IUI will require more randomized controlled trials.
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Affiliation(s)
- Pier Paolo Brollo
- General Surgical Oncology Department, IRCCS CRO di Aviano (Istituto Nazionale Tumori), Aviano, Italy.
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy.
| | - Alessandro Puggioni
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Francesco Tumminelli
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Antonio Colangelo
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Carlo Biddau
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Vittorio Cherchi
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Bresadola
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
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16
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McCarus SD, Shortridge EF, Kimura T, Feng Q, Han W, Jiang B. Long-term economic outcomes of ureteral injury in the United States. Curr Med Res Opin 2024; 40:325-333. [PMID: 37961772 DOI: 10.1080/03007995.2023.2283204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Ureteral injuries (UIs) during surgical procedures can have serious consequences for patients. Although UIs can result in substantial clinical burden, few studies report the impact of these injuries on payer reimbursement and patient cost-sharing. This retrospective study evaluated 30-day, 90-day, and 1-year healthcare resource utilization for patients with UIs and estimated patient and payer costs. METHODS Patients aged ≥ 12 years who underwent abdominopelvic surgery from January 2016 to December 2018 were identified in a United States claims database. Patients were followed for 1 year to estimate all-cause healthcare visits and costs for patients and payers. Surgeries resulting in UIs within 30 days from the surgery date were matched to surgeries without UIs to estimate UI-attributable visits and costs. RESULTS Five hundred and twenty-two patients with UIs were included. Almost a third (29.9%) of patients with UIs had outpatient surgery. Patients with UIs had slightly more healthcare visits and a 15.3% higher 30-day hospital readmission rate than patients without UIs. Patient costs due to UIs were not statistically significant, but annual payer costs attributable to UIs were $38,859 (95% CI = 28,142-49,576), largely driven by inpatient costs. CONCLUSIONS UIs add substantial cost for payers and result in more healthcare visits for patients. These findings highlight the importance of including inpatient and outpatient settings for UI prevention. Although UIs are rare, the associated patient and payer burdens are high; thus, protocols or techniques are needed to recognize and avert UIs as current guideline recommendations are lacking.
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Affiliation(s)
- Steven D McCarus
- Gynecological Surgery Department, Advent Health Winter Park Hospital, Winter Park, FL, USA
| | - Emily F Shortridge
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Tomomi Kimura
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Qi Feng
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Wei Han
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | - Baoguo Jiang
- Health Economics and Outcomes Research, Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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17
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Souli A, Alves A, Tillou X, Menahem B. Iatrogenic ureteral injury: What should the digestive surgeon know? J Visc Surg 2024; 161:6-14. [PMID: 38242812 DOI: 10.1016/j.jviscsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE OF THE STUDY Iatrogenic ureteral injury (IUI) is a rare but formidable complication of any abdominal or pelvic surgery. The aim of this study was to describe the epidemiology of IUI in colorectal surgery in the Basse-Normandie region over the period 2004-2022, as well as to review the literature on the management of this complication. MATERIALS AND METHODS This multicenter retrospective analysis of clinical data (medical records and operative reports) concerned 22 patients (13 men and 9 women) who suffered an IUI during colorectal surgery between 2004 and 2022. Ureteral resections for oncological purposes and endoluminal instrumental injuries (post-ureteroscopy) were excluded from the study. We also carried out a review of the literature concerning the incidence of IUI in colorectal surgery. RESULTS The incidence of IUI was 0.27% over the study period (22 ureteral injuries out of 8129 colorectal procedures). Colorectal cancer and sigmoid diverticulitis were the dominant surgical indications (85% of cases). Proctectomy and left colectomy were the most performed resection procedures (75% of cases). Surgery was scheduled in 68% of cases. The approach was open laparotomy in 59% and laparoscopy in 41% of cases. The IUI involved the left ureter in 63% of cases and the pelvic ureter in 77% of cases. Conservative endoscopic treatment by insertion of a double-J catheter stent had a success rate of 87.5%. Surgical repairs consisting of re-implantation techniques and uretero-ureteral anastomosis had a success rate of 75%. The nephrectomy rate was 13.6% (3/22) and the mortality rate 9% (2/22). A literature review identified sixteen studies, where the incidence of IUI varied from 0.1 to 4.5%. FINDINGS IUI occurring during colorectal surgery is a rare occurrence but remain a formidable complication. No means of prevention has proven its effectiveness to date, but guidance devices using illuminated ureteral catheters or dyes seem to constitute a promising approach. Injuries to the left pelvic ureter are the most common, and the majority can be treated endoscopically if diagnosed early.
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Affiliation(s)
- Abdelaziz Souli
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Arnaud Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France
| | - Xavier Tillou
- Department of urology, university hospital of Caen, Caen, France
| | - Benjamin Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France.
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18
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Matkov TG, Curry LS, Ochoa AL. Risk stratification of acute kidney injury (AKI) following ureteral stent insertion for colorectal surgery. Surg Endosc 2024; 38:312-318. [PMID: 37749203 DOI: 10.1007/s00464-023-10440-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/01/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ureteral stents have long been utilized during colorectal resections to assist in the identification of ureters intraoperatively and mitigate risk of ureteral injury. As these procedures have shifted toward robot-assisted laparoscopic methods, lighted stents have increasingly been used. The incidence of acute kidney injury (AKI) following bilateral ureteral stent placement has been reported to be as high as 41.9%. We sought to identify our single-institution risk and determine the extent to which age, sex, and stent type affected incidence of AKI. METHODS A retrospective analysis was performed at a single community hospital of all open and robotic-assisted laparoscopic colorectal surgeries from October 2012 to April 2022. If requested, ureteral stents were placed bilaterally by a urologist and later removed by the surgeon. Non-lighted stents used were 5 Fr whistle-tip (BARD); lighted stents were 6 Fr with a fiberoptic core (STRYKER). Kidney failure was described as a rise of creatinine to ≥ 1.5 times the preoperative value, per KDIGO guidelines. RESULTS 633 consecutive colorectal surgeries were evaluated, with no stents placed in 237 cases, non-lighted stents placed in 137 cases, and lighted stents placed in 259 cases. No ureteral injuries were observed. Overall incidence of AKI for non-stented surgeries was 0.8% vs 5.8% for non-lighted stents and 5.8% for lighted stents. Patient age was the most significant factor in AKI incidence: for patients under 60, there was no statistical difference in AKI incidence for stented vs non-stented procedures (2.2% vs 1.1%). For patients over 60, the risk of AKI was 10.5% for stented vs 0.7% for non-stented. Female patients had statistically significant risk differences, with AKI incidence of 7.1% stented vs 0.0% non-stented. AKI completely resolved in all cases, regardless of cohort. CONCLUSIONS In patients under age 60, the use of stents was not associated with an increased risk of AKI. For women and those over 60, stents pose a higher risk of transient AKI. Overall incidence of AKI in our larger and single-institution community hospital population was significantly lower than reported in other studies. No statistical difference was observed, overall, in AKI incidence between lighted and non-lighted stents.
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Affiliation(s)
- Thomas G Matkov
- Department of Urology, Aurora Medical Center-Kenosha, Kenosha, WI, USA.
| | - Laurel S Curry
- Biomedical Engineering Student, Cornell University, Ithaca, NY, USA
| | - Alma L Ochoa
- Department of Urology, Aurora Medical Center-Kenosha, Kenosha, WI, USA
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19
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Dezzani EO. Minimally invasive surgery: an overview. Minerva Surg 2023; 78:616-625. [PMID: 38059439 DOI: 10.23736/s2724-5691.23.10126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
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20
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Chen KA, Joisa CU, Stem JM, Guillem JG, Gomez SM, Kapadia MR. Prediction of Ureteral Injury During Colorectal Surgery Using Machine Learning. Am Surg 2023; 89:5702-5710. [PMID: 37133432 PMCID: PMC10622328 DOI: 10.1177/00031348231173981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ureteral injury (UI) is a rare but devastating complication during colorectal surgery. Ureteral stents may reduce UI but carry risks themselves. Risk predictors for UI could help target the use of stents, but previous efforts have relied on logistic regression (LR), shown moderate accuracy, and used intraoperative variables. We sought to use an emerging approach in predictive analytics, machine learning, to create a model for UI. METHODS Patients who underwent colorectal surgery were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were split into training, validation, and test sets. The primary outcome was UI. Three machine learning approaches were tested including random forest (RF), gradient boosting (XGB), and neural networks (NN), and compared with traditional LR. Model performance was assessed using area under the curve (AUROC). RESULTS The data set included 262,923 patients, of whom 1519 (.578%) experienced UI. Of the modeling techniques, XGB performed the best, with an AUROC score of .774 (95% CI .742-.807) compared with .698 (95% CI .664-.733) for LR. Random forest and NN performed similarly with scores of .738 and .763, respectively. Type of procedure, work RVUs, indication for surgery, and mechanical bowel prep showed the strongest influence on model predictions. CONCLUSIONS Machine learning-based models significantly outperformed LR and previous models and showed high accuracy in predicting UI during colorectal surgery. With proper validation, they could be used to support decision making regarding the placement of ureteral stents preoperatively.
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Affiliation(s)
- Kevin A. Chen
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Chinmaya U. Joisa
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - Jonathan M. Stem
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Jose G. Guillem
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Shawn M. Gomez
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - Muneera R. Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
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21
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Zhao Y, Tan WJ. Ureteral Injury. Dis Colon Rectum 2023; 66:1421-1424. [PMID: 37594904 DOI: 10.1097/dcr.0000000000003032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
CASE SUMMARY A 70-year-old man underwent laparoscopic low anterior resection for a rectal adenocarcinoma after neoadjuvant chemoradiotherapy. Postoperatively, the patient had high drain volume output, with 800 mL of clear serous fluid being drained on the second postoperative day. Drain creatinine returned as 300 mmol/L, with a corresponding serum creatinine of 100 mmol/L. CT scan of the abdomen and pelvis confirmed a left ureteric injury with an associated urinoma. After urology consultation, the patient underwent a left ureteric reimplantation emergently.
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Affiliation(s)
- Yue Zhao
- Ministry of Health Holdings, Singapore
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22
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Othman B, Pham T, Mohan H, Rajkomar A, Heriot AG, Smart P, Warrier S. Use of ureteric catheters and indocyanine green in complex pelvic surgery: a must or a luxury in 2023? ANZ J Surg 2023; 93:2287-2288. [PMID: 37431068 DOI: 10.1111/ans.18603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Bushra Othman
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Toan Pham
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Colorectal Surgery, Northern Hospital, Epping, Victoria, Australia
- Department of General Surgery, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Amrish Rajkomar
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Philip Smart
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Satish Warrier
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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23
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Lim ZY, Mohan S, Balasubramaniam S, Ahmed S, Siew CCH, Shelat VG. Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green. World J Gastrointest Surg 2023; 15:1841-1857. [PMID: 37901741 PMCID: PMC10600780 DOI: 10.4240/wjgs.v15.i9.1841] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
Indocyanine green (ICG) is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery. ICG facilitates anatomical identification of structures (e.g., ureters), assessment of lymph nodes, biliary mapping, organ perfusion and anastomosis assessment, and aids in determining the adequacy of oncological margins. In addition, ICG can be conjugated to artificially created antibodies for tumour markers, such as carcinoembryonic antigen for colorectal, breast, lung, and gastric cancer, prostate-specific antigen for prostate cancer, and cancer antigen 125 for ovarian cancer. Although ICG has shown promising results, the optimization of patient factors, dye factors, equipment, and the method of assessing fluorescence intensity could further enhance its utility. This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies. With the emergence of robotic technology and the increasing reporting of ICG utility, a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.
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Affiliation(s)
- Zavier Yongxuan Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Swetha Mohan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | | | - Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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24
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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Albert M, Delgado-Herrera L, Paruch J, Gerritsen-van Schieveen P, Kishimoto T, Takusagawa S, Cai N, Fengler J, Raizer J. Pudexacianinium (ASP5354) chloride for ureter visualization in participants undergoing laparoscopic, minimally invasive colorectal surgery. Surg Endosc 2023; 37:7336-7347. [PMID: 37474823 PMCID: PMC10462524 DOI: 10.1007/s00464-023-10193-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Intraoperative ureteral injury, a serious complication of abdominopelvic surgeries, can be avoided through ureter visualization. Near-infrared fluorescence imaging offers real-time anatomical visualization of ureters during surgery. Pudexacianinium (ASP5354) chloride is an indocyanine green derivative under investigation for intraoperative ureter visualization during colorectal or gynecologic surgery in adult and pediatric patients. METHODS In this phase 2 study (NCT04238481), adults undergoing laparoscopic colorectal surgery were randomized to receive one intravenous dose of pudexacianinium 0.3 mg, 1.0 mg, or 3.0 mg. The primary endpoint was successful intraoperative ureter visualization, defined as observation of ureter fluorescence 30 min after pudexacianinium administration and at end of surgery. Safety and pharmacokinetics were also assessed. RESULTS Participants received pudexacianinium 0.3 mg (n = 3), 1.0 mg (n = 6), or 3.0 mg (n = 3). Most participants were female (n = 10; 83.3%); median age was 54 years (range 24-69) and median BMI was 29.3 kg/m2 (range 18.7-38.1). Successful intraoperative ureter visualization occurred in 2/3, 5/6, and 3/3 participants who received pudexacianinium 0.3 mg, 1.0 mg, or 3.0 mg, respectively. Median intensity values per surgeon assessment were 1 (mild) with the 0.3-mg dose, 2 (moderate) with the 1.0-mg dose, and 3 (strong) with the 3.0-mg dose. A correlation was observed between qualitative (surgeon's recognition/identification of the ureter during surgery) and quantitative (video recordings of the surgeries after study completion) assessment of fluorescence intensity. Two participants experienced serious adverse events, none of which were drug-related toxicities. One adverse event (grade 1 proteinuria) was related to pudexacianinium. Plasma pudexacianinium concentrations were dose-dependent and the mean (± SD) percent excreted into urine during surgery was 22.3% ± 8.0% (0.3-mg dose), 15.6% ± 10.0% (1.0-mg dose), and 39.5% ± 12.4% (3.0-mg dose). CONCLUSIONS In this study, 1.0 and 3.0 mg pudexacianinium provided ureteral visualization for the duration of minimally invasive, laparoscopic colorectal procedures and was safe and well tolerated.
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Affiliation(s)
- Matthew Albert
- Department of Colorectal Surgery, Advent Health, 2415 N Orange Ave Ste 300, Orlando, FL, 32804, USA.
| | | | | | | | | | | | - Na Cai
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Jeffrey Raizer
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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26
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Deng L, Tang S, Dou Y, Li Y, Liang Z, Wang Y. The efficacy of ureteroscopic triage in increasing the cure rate of the first-line treatment for a ureterovaginal fistula resulting from radical hysterectomy. Heliyon 2023; 9:e18389. [PMID: 37520954 PMCID: PMC10374918 DOI: 10.1016/j.heliyon.2023.e18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
Study objective To explore the effect of pretreatment with ureteroscopic triage for iatrogenic ureterovaginal fistula (UVF) resulting from radical hysterectomy. Design A retrospective cohort study. Setting Department of gynecology at a tertiary medical center. Patients Women diagnosed with UVF secondary to radical hysterectomy at our center between April 2008 to June 2018. Interventions The patients were divided into two groups according to whether pretreatment with ureteroscopic triage was performed. Those in the non-triage group underwent retrograde placement of a double-J stent immediately following diagnosis as the first-line therapy. Patients in the triage group were first evaluated under ureteroscopy, their ureteral injuries were then classified into different grades and then underwent different treatments as the first-line therapy, including stent placement or reconstruction surgeries. The cure rate of the first-line therapy and the timeliness of the implementation of adjuvant radiotherapy were subsequently analyzed. Measurements and main results Ninety-eight UVF patients were included. The demographics, ECOG status, stage of cervical cancer (FIGO 2009), types and onset time of symptoms were not different between the two groups. There were 54 patients in the nontriage group, with an overall first-line cure rate of 70.4% and a timely implementation rate of adjuvant radiotherapy of 38.5%. There were 44 patients in the evaluation group, with an overall first-line cure rate of 93.2% and a timely implementation rate of adjuvant radiotherapy of 90.0%. The differences were statistically significant (p < 0.001). Conclusion Ureteroscopic triage of ureteral injuries can guide the selection of the optimal first-line therapy for patients with UVF secondary to radical hysterectomy, increase the cure rate and ensure the timely implementation of adjuvant radiotherapy.
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27
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He A, Li X, Dai Z, Li Q, Zhang Y, Ding M, Wen ZF, Mou Y, Dong H. Nanovaccine-based strategies for lymph node targeted delivery and imaging in tumor immunotherapy. J Nanobiotechnology 2023; 21:236. [PMID: 37482608 PMCID: PMC10364424 DOI: 10.1186/s12951-023-01989-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Therapeutic tumor vaccines have attracted considerable attention in the past decade; they can induce tumor regression, eradicate minimal residual disease, establish lasting immune memory and avoid non-specific and adverse side effects. However, the challenge in the field of therapeutic tumor vaccines is ensuring the delivery of immune components to the lymph nodes (LNs) to activate immune cells. The clinical response rate of traditional therapeutic tumor vaccines falls short of expectations due to inadequate lymph node delivery. With the rapid development of nanotechnology, a large number of nanoplatform-based LN-targeting nanovaccines have been exploited for optimizing tumor immunotherapies. In addition, some nanovaccines possess non-invasive visualization performance, which is benefit for understanding the kinetics of nanovaccine exposure in LNs. Herein, we present the parameters of nanoplatforms, such as size, surface modification, shape, and deformability, which affect the LN-targeting functions of nanovaccines. The recent advances in nanoplatforms with different components promoting LN-targeting are also summarized. Furthermore, emerging LNs-targeting nanoplatform-mediated imaging strategies to both improve targeting performance and enhance the quality of LN imaging are discussed. Finally, we summarize the prospects and challenges of nanoplatform-based LN-targeting and /or imaging strategies, which optimize the clinical efficacy of nanovaccines in tumor immunotherapies.
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Affiliation(s)
- Ao He
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Xiaoye Li
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Zhuo Dai
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Qiang Li
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Yu Zhang
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Meng Ding
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China
| | - Zhi-Fa Wen
- Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
| | - Yongbin Mou
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China.
| | - Heng Dong
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, 30 Zhongyang Road, Nanjing, 210008, China.
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McCarus S, Alexandre AF, Kimura T, Feng Q, Han W, Shortridge EF, Lima RB, Schwartz J, Wexner SD. Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015-2019. Adv Ther 2023; 40:3169-3185. [PMID: 37227585 PMCID: PMC10272259 DOI: 10.1007/s12325-023-02515-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries. METHODS We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression. RESULTS Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis). CONCLUSION Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.
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Affiliation(s)
- Steven McCarus
- Gynecological Surgery, Advent Health Winter Park Hospital, Winter Park, FL, USA
| | - Ana Filipa Alexandre
- Health Economics and Outcomes Research, Astellas Pharma Europe B.V., Leiden, The Netherlands
| | - Tomomi Kimura
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Qi Feng
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Wei Han
- Data Science, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Emily F Shortridge
- Medical Affairs, Astellas Gene Therapies, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Robson Barbosa Lima
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Jason Schwartz
- Medical Affairs, Astellas Gene Therapies, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Rekouna K, Dimitrokallis N, Kypraios C, Kontothanasis D, Vougas V. Heterotopic Kidney Autotransplantation for Recurrent Iatrogenic Distal Ureteral Injury: A Case Report. Cureus 2023; 15:e38036. [PMID: 37228518 PMCID: PMC10206520 DOI: 10.7759/cureus.38036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Iatrogenic ureteral injuries are a significant complication during pelvic surgery, requiring a multidisciplinary approach for optimal repair. When a ureteral injury is suspected postoperatively, abdominal imaging is essential to determine the type of injury and thus the timing and method of reconstruction. That can be performed either by a CT pyelogram or by an ureterography-cystography with or without ureter stenting. Although technological advancements and minimally invasive surgery have been gaining ground over open complex surgeries, renal autotransplantation is a well-established technique of proximal ureter repair and should be highly considered when dealing with a severe injury. We hereby report the case of a patient with a recurrent ureter injury and multiple laparotomies treated with autotransplantation, without any major morbidities or change in their quality of life. In every case, a personalized approach for each patient and consultation with experienced transplant experts (surgeons, urologists, and nephrologists) is advised.
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Affiliation(s)
- Konstantina Rekouna
- 1st Department of Surgery and Transplantation, Evangelismos General Hospital, Athens, GRC
| | - Nikolaos Dimitrokallis
- 1st Department of Surgery and Transplantation, Evangelismos General Hospital, Athens, GRC
| | | | | | - Vasileios Vougas
- 1st Department of Surgery and Transplantation, Evangelismos General Hospital, Athens, GRC
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30
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De Muzio F, Fusco R, Cutolo C, Giacobbe G, Bruno F, Palumbo P, Danti G, Grazzini G, Flammia F, Borgheresi A, Agostini A, Grassi F, Giovagnoni A, Miele V, Barile A, Granata V. Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications. J Clin Med 2023; 12:1489. [PMID: 36836024 PMCID: PMC9966470 DOI: 10.3390/jcm12041489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Rectal cancer (RC) is one of the deadliest malignancies worldwide. Surgery is the most common treatment for RC, performed in 63.2% of patients. The type of surgical approach chosen aims to achieve maximum residual function with the lowest risk of recurrence. The selection is made by a multidisciplinary team that assesses the characteristics of the patient and the tumor. Total mesorectal excision (TME), including both low anterior resection (LAR) and abdominoperineal resection (APR), is still the standard of care for RC. Radical surgery is burdened by a 31% rate of major complications (Clavien-Dindo grade 3-4), such as anastomotic leaks and a risk of a permanent stoma. In recent years, less-invasive techniques, such as local excision, have been tested. These additional procedures could mitigate the morbidity of rectal resection, while providing acceptable oncologic results. The "watch and wait" approach is not a globally accepted model of care but encouraging results on selected groups of patients make it a promising strategy. In this plethora of treatments, the radiologist is called upon to distinguish a physiological from a pathological postoperative finding. The aim of this narrative review is to identify the main post-surgical complications and the most effective imaging techniques.
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Affiliation(s)
- Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | | | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Grazzini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Federica Flammia
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli”, 80131 Naples, Italy
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Yang H, Zhang Z, Fu W, Zhang X, Sun Y, Zhang Q. Procedural dissection of the ureterohypogastric nerve fascia for locally advanced rectal cancer with adnexal infiltration: A video vignette. Colorectal Dis 2023; 25:328-330. [PMID: 35984733 DOI: 10.1111/codi.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/10/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Hongjie Yang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zhichun Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Wenzheng Fu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yi Sun
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
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Rodríguez-Zentner H, Cukier M, Montagne V, Arrue E. Ureteral identification with indocyanine green in laparoscopic colorectal surgery. Asian J Endosc Surg 2022; 16:312-316. [PMID: 36562203 DOI: 10.1111/ases.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. MATERIALS AND SURGICAL TECHNIQUE We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. RESULTS We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4 minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration. DISCUSSION Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.
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Affiliation(s)
- Homero Rodríguez-Zentner
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Moises Cukier
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Vianette Montagne
- Division of Urology, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
| | - Emmy Arrue
- Division of General Surgery, Department of Surgery, Pacifica Salud Hospital, Panama City, Panama
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Sungur U, Polat H, Yılmaz H, Güner E. Multidisciplinary Collaborative Operations of Urology and Other Surgical Specialties: Thirteen Years of Experience at a Single Center. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Joosten JJ, Sharabiany S, Musters GD, Beerlage HP, Tanis PJ, Bemelman WA, Hompes R. Iatrogenic injury of the urinary tract during salvage procedures for pelvic sepsis: Experience of a national referral centre. Colorectal Dis 2022; 24:1397-1404. [PMID: 35698898 PMCID: PMC9796761 DOI: 10.1111/codi.16221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 06/06/2022] [Indexed: 01/07/2023]
Abstract
AIM This study aimed to determine the incidence, consequences and outcomes of iatrogenic urinary tract injury (IUI) during salvage surgery for pelvic sepsis. METHOD Patients who underwent salvage surgery for pelvic sepsis after prior low anterior resection or Hartmann's procedure for rectal cancer were prospectively maintained in a database between 2010 and 2020 and reviewed retrospectively. The primary endpoint was the incidence of IUI. Secondary endpoints were timing of diagnosis (intra- vs. postoperative), reinterventions related to the IUI and healing of IUI. RESULTS In total 126 consecutive patients were included, and IUI occurred in 13 patients (10%). A ureteric injury occurred in eight patients, bladder injury in four patients and a urethral injury in one patient. All patients with an IUI had radiotherapy as neoadjuvant treatment. The IUI was diagnosed postoperatively in 63% (n = 8/13) with a median duration between surgery and diagnosis of the IUI of 10 days (IQR: 6-15). The median number of reinterventions was five (range 1-31) in the group with a postoperative diagnosis and one (range 0-1) in the group with an intraoperative diagnosis. Four patients required a surgical reintervention, all concerning injuries diagnosed postoperatively. At the end of follow-up, 85% of patients (n = 11/13) had a healed IUI. CONCLUSION Iatrogenic urinary tract injury is not uncommon in salvage procedures for pelvic sepsis, even in an experienced tertiary referral centre. Most injuries were diagnosed postoperatively which affects the severity of these complications, emphasising the need to improve intraoperative diagnostic modalities.
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Affiliation(s)
- Johanna J. Joosten
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gijsbert D. Musters
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Harrie P. Beerlage
- Department of Urology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre AmsterdamUniversity of AmsterdamAmsterdamThe Netherlands,Department of Surgical Oncology and Gastrointestinal SurgeryRotterdamThe Netherlands
| | | | - Roel Hompes
- Department of Surgery, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Image Navigation Surgery With the Fluorescent Ureteral Catheter of Recurrent Tumors in the Pelvic Cavity. Dis Colon Rectum 2022; 65:e72-e76. [PMID: 34990431 DOI: 10.1097/dcr.0000000000002144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors. TECHNIQUE The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum. RESULTS All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter. CONCLUSION Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.
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Chen X, Chen J, Maria Cananzi FC, Li W, Quagliuolo V, Luo C, Yang Y. Prophylactic Ureteral Catheter Placement Appears to Reduce Intraoperative Ureteric Injury During Resection of Primary Retroperitoneal Liposarcoma. Technol Cancer Res Treat 2022; 21:15330338221087831. [PMID: 35440255 PMCID: PMC9047802 DOI: 10.1177/15330338221087831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Prophylactic ureteral catheters placement (PUCP) was advocated as an effective strategy for decreasing ureteral morbidities in colorectal surgeries. However, whether it should be routinely used prior to primary retroperitoneal liposarcoma (PRLS) surgeries remains unknown. Methods: It was a retrospective study, conducted at a tertiary sarcoma center. Medical records of patients with PRLS undergoing surgeries from January 2015 through December 2018 were reviewed. Primary endpoint was the rate of ureteral morbidities during and after retroperitoneal liposarcoma resection procedures. Univariate and multivariate analyses determined risk factors associated with ureteral injury (UI) in patients undergoing surgeries. Results: A total of 55 patients of PRLS were included. Fourteen (25.5%) patients underwent PUCP, with 1 UI (7.1%) identified. In 41 patients with no PUCP, 15 (36.6%) exhibited UIs during and post surgeries. There were significant improvements of UIs in group PUCP, compared with patients without PUCP (P < .05). Resection surgeries combined with colectomy and tumor-ureter relationship were 2 risk factors significantly associated to UIs (P < .01). Conclusions: PUCP might be an effective way of preventing UIs in patients with PRLS. It could be suggested especially in patients with ureter encased by tumor or anticipated colectomy during the surgical process.
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Affiliation(s)
- Xiaobing Chen
- 26447Peking University First Hospital, Beijing, China.,594822Peking University International Hospital, Beijing, China
| | - Jun Chen
- 594822Peking University International Hospital, Beijing, China
| | - Ferdinando Carlo Maria Cananzi
- 437807Humanitas University, Pieve Emanuele-Milan, Italy.,Sarcoma, Melanoma and Rare Tumors Surgery Unit, 9268IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Wenjie Li
- 594822Peking University International Hospital, Beijing, China
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, 9268IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Chenghua Luo
- 594822Peking University International Hospital, Beijing, China
| | - Yinmo Yang
- 26447Peking University First Hospital, Beijing, China
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Binda GA, Amato A, Schultz J. Elective Surgery. COLONIC DIVERTICULAR DISEASE 2022:347-359. [DOI: 10.1007/978-3-030-93761-4_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Huang ZX, Zhou Z, Shi HR, Li TY, Ye SP. Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg 2021; 13:1660-1672. [PMID: 35070071 PMCID: PMC8727186 DOI: 10.4240/wjgs.v13.i12.1660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/16/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.
AIM To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.
METHODS In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.
RESULTS Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.
CONCLUSION Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.
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Affiliation(s)
- Zhi-Xiang Huang
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen Zhou
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hao-Ran Shi
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Shan-Ping Ye
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Dolejs SC, Nicolas M, Maun DC, Lane FR, Waters JA, Tsai BM. Localizing ureteral catheters for left-sided colectomy and proctectomy: Do the risks justify the benefits? Am J Surg 2021; 223:505-508. [PMID: 34996612 DOI: 10.1016/j.amjsurg.2021.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/16/2021] [Accepted: 12/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The role of ureteral catheters in left-sided colectomies and proctectomies remains debated. Given the rarity of ureteral injury, prior retrospective studies were underpowered to detect potentially small, but meaningful differences. This study seeks to determine the role and morbidity of ureteral catheters in left-sided colectomy and proctectomy using a large, national database. METHODS The National Surgical Quality Improvement Project from 2012 to 2018 was queried. Left-sided colectomies or proctectomies were included. Propensity score matching and multivariable logistic regression analysis was performed. RESULTS 8419 patients with ureteral catherization and 128,021 patients without catheterization were included. After matching, there was not a significant difference in ureteral injury between the groups (0.7% with vs 0.9% without, p = 0.07). Ureteral catheters were associated with increased overall morbidity and longer operative time. Increasing body mass index, operations for diverticular disease, conversion to open, T4 disease and increasing operative complexity were associated with ureteral injury (p < 0.01 for all). CONCLUSIONS Ureteral catheterization was not associated with decreased rates of ureteral injury when including all left-sided colectomies. High-risk patients for ureteral injury include those with obesity, diverticular disease, and conversion to open. Selective ureteral catheterization may be warranted in these settings.
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Affiliation(s)
- Scott C Dolejs
- Indiana University School of Medicine, Department of Surgery, USA; Midwest Colon and Rectal Surgery, 13421 Old Meridian St, Carmel, IN, 46032, USA.
| | - Megan Nicolas
- Indiana University School of Medicine, Department of Surgery, USA.
| | - Dipen C Maun
- Indiana University School of Medicine, Department of Surgery, USA.
| | - Frederick R Lane
- Indiana University School of Medicine, Department of Surgery, USA.
| | - Joshua A Waters
- Indiana University School of Medicine, Department of Surgery, USA.
| | - Ben M Tsai
- Indiana University School of Medicine, Department of Surgery, USA.
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Hanna DN, Hermina A, Bradley E, Ghani MO, Mina A, Bailey CE, Idrees K, Magge D. Safety and Clinical Value of Prophylactic Ureteral Stenting Before Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy. Am Surg 2021:31348211058622. [PMID: 34844443 DOI: 10.1177/00031348211058622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prophylactic ureteral stents (PUS) are typically placed prior to complex abdominal or pelvic operations at the surgeon's discretion to help facilitate detection of iatrogenic ureteral injury. However, its usefulness and safety in the setting of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) have not been examined. This study aims to evaluate the potential clinical value and risk profile of prophylactic ureteral stent placement prior to CRS-HIPEC. METHODS We performed a single-institutional retrospective analysis of 145 patients who underwent CRS-HIPEC from 2013 to 2021. Demographic and operative characteristics were compared between patients who underwent PUS placement and those that did not. Ureteral stent-related complications were evaluated. RESULTS Of the 145 patients included in the analysis, 124 underwent PUS placement. There were no significant differences in patient demographics, medical comorbidities, or tumor characteristics. Additionally, PUS placement did not significantly increase operative time and was not associated with increased pelvic organ resection. However, patients who underwent prophylactic ureteral stenting had significantly higher peritoneal carcinomatosis index score (15.1 vs 9.1, P=.002) and increased rate of ureteral complications (24.2% vs 14.3%, P=.04), which led to lengthened hospital stay (13.2 days vs 8.1 days, P= .03). Notably, the sole ureteral injury and three cases of hydronephrosis were seen in patients who underwent PUS. CONCLUSION Prophylactic ureteral stent placement in patients undergoing CRS-HIPEC may be useful, particularly in patients with predetermined extensive pelvic disease. However, PUS placement is not without potential morbidity and should be selectively considered in patients for whom benefits outweigh the risks.
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Affiliation(s)
- David N Hanna
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
| | | | - Emma Bradley
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
| | - Muhammad O Ghani
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
| | - Alexander Mina
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christina E Bailey
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
| | - Kamran Idrees
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
| | - Deepa Magge
- Vanderbilt University Medical Center, Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Nashville, TN, USA
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Peltrini R, Podda M, Castiglioni S, Di Nuzzo MM, D'Ambra M, Lionetti R, Sodo M, Luglio G, Mucilli F, Di Saverio S, Bracale U, Corcione F. Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art. World J Gastroenterol 2021; 27:6374-6386. [PMID: 34720528 PMCID: PMC8517789 DOI: 10.3748/wjg.v27.i38.6374] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/30/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari 09100, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | | | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Gaetano Luglio
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Felice Mucilli
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese 21100, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
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Murase T, Takizawa M, Galitz L, Flach S, Murray V, Gufford B, Suwa A. Randomized, Double-Blind, Controlled Study to Evaluate Safety and Pharmacokinetics of Single Ascending Doses of ASP5354, an Investigational Imaging Product, in Healthy Adult Volunteers. Clin Pharmacol Drug Dev 2021; 10:1460-1468. [PMID: 34427049 PMCID: PMC9292347 DOI: 10.1002/cpdd.1013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
Intraoperative ureter identification helps reduce the risk of ureteral injury. Currently, no suitable agents for real‐time ureter visualization are approved. ASP5354 (TK‐1) is a novel indocyanine green derivative. In this first‐in‐human phase 1, double‐blind, sequential ascending‐dose study, urethral catheters were placed in 6 healthy volunteers who were randomized to single‐dose, intravenous ASP5354 0.1 mg (n = 4) or placebo (n = 2). Sequential dose escalations to 0.5‐, 2‐, 8‐, and 24‐mg ASP5354 in new cohorts were contingent upon Dose‐Escalation Committee approval after review of pharmacokinetic (PK) and safety data. Blood and urine samples were collected over 24 hours following dose administration. Objectives were to assess the safety/tolerability and PK of ASP5354. Treatment‐emergent adverse events (TEAEs) were reported in 3 (15%) and 2 (20%) participants in the ASP5354 and placebo groups, respectively. In the former, there were 6 TEAEs (5/6 grade 1‐2). One ASP5354 participant experienced grade 3 pyelonephritis, attributed to the catheter. No TEAEs were related to ASP5354. Mean plasma terminal elimination half‐life ranged from 2.1 to 3.6 hours, with near complete urinary excretion of unchanged ASP5354 within 24 hours after administration. Linear and dose‐proportional PK were observed. These results support further evaluation of ASP5354 at doses up to 24 mg for intraoperative near‐infrared fluorescence ureter visualization.
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Affiliation(s)
| | | | | | - Stephen Flach
- Labcorp Drub Development Inc, Madison, Wisconsin, USA
| | | | | | - Akira Suwa
- Rx+ Business Accelerator, Astellas Pharma Inc, Ibaraki, Japan
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Zocola E, Meyer J, Christou N, Liot E, Toso C, Buchs NC, Ris F. Role of near-infrared fluorescence in colorectal surgery. World J Gastroenterol 2021; 27:5189-5200. [PMID: 34497444 PMCID: PMC8384744 DOI: 10.3748/wjg.v27.i31.5189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Near-infrared fluorescence (NIRF) is a technique of augmented reality that, when applied in the operating theatre, allows the colorectal surgeon to visualize and assess bowel vascularization, to identify lymph nodes draining a cancer site and to identify ureters. Herein, we review the literature regarding NIRF in colorectal surgery.
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Affiliation(s)
- Elodie Zocola
- Medical School, University of Geneva, Genève 1205, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges Cedex 87025, France
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
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44
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Soriano CR, Cheng RR, Corman JM, Moonka R, Simianu VV, Kaplan JA. Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections. Am J Surg 2021; 223:14-20. [PMID: 34353619 DOI: 10.1016/j.amjsurg.2021.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/01/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ureteral identification is essential to performing safe colorectal surgery. Injected immunofluorescence may aid with ureteral identification, but feasibility without ureteral catheterization is not well described. METHODS Case series of robotic colorectal resections where indocyanine green (ICG) injection with or without ureteral catheter placement was performed. Imaging protocol, time to ureteral identification, and factors impacting visualization are reported. RESULTS From 2019 to 2020, 83 patients underwent ureteral ICG injection, 20 with catheterization and 63 with injection only. Main indications were diverticulitis (52%) and cancer (36%). Median time to instill ICG was faster with injection alone than with catheter placement (4min vs 13.5min, p < 0.001). Median time [IQR] to right ureter (0.3 [0.01-1.2] min after robot docking) and left ureter (5.5 [3.1-8.8] min after beginning dissection) visualization was not different between injection alone and catheterization. CONCLUSION ICG injection alone is faster than with indwelling catheter placement and equally reliable at intraoperative ureteral identification.
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Affiliation(s)
- Celine R Soriano
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
| | - Ron Ron Cheng
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - John M Corman
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
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45
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Pallan A, Dedelaite M, Mirajkar N, Newman PA, Plowright J, Ashraf S. Postoperative complications of colorectal cancer. Clin Radiol 2021; 76:896-907. [PMID: 34281707 DOI: 10.1016/j.crad.2021.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is the third most common cancer, and surgery is the most common treatment. Several surgical options are available, but each is associated with a range of potential complications. The timely and efficient identification of these complications is vital for effective clinical management of these patients in order to minimise their morbidity and mortality. This review aims to describe the range of commonly performed surgical treatments for colorectal surgery. In addition, frequent post-surgical complications are explored with investigative options explained and illustrated.
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Affiliation(s)
- A Pallan
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - M Dedelaite
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - N Mirajkar
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P A Newman
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Plowright
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - S Ashraf
- Department of Colorectal Surgery, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
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46
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Mayo JS, Brazer ML, Bogenberger KJ, Tavares KB, Conrad RJ, Lustik MB, Gillern SM, Park CW, Richards CR. Ureteral injuries in colorectal surgery and the impact of laparoscopic and robotic-assisted approaches. Surg Endosc 2021; 35:2805-2816. [PMID: 32591939 DOI: 10.1007/s00464-020-07714-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ureteral injury is a feared complication in colorectal surgery that has been increasing over the past decade. Some have attributed this to an increased adoption of minimally invasive surgery (MIS), but the literature is hardly conclusive. In this study we aim to further assess the overall trend of ureteral injuries in colorectal surgery, and investigate propensity adjusted contributions from open and MIS to include robotic-assisted surgery. METHODS This is a retrospective analysis of colorectal surgeries from 2006 to 2016 using the Nationwide Inpatient Sample (NIS) database. Multivariable logistic regression was performed to identify predisposing and protective factors. Demographics, hospital factors, and case-mix differences for open and MIS were accounted for via propensity analysis. The NIS coding structure changed in 2015, which could introduce a potential source of incongruity in complication rates over time. As a result, all statistical analyses included only the first nine years of data, or were conducted before and after the change for comparison. RESULTS Of 514,162 colorectal surgeries identified there were 1598 ureteral injuries (0.31%). Ureteral injuries were found to be increasing through 2015 (2.3/1000 vs 3.3/1000; p < 0.001) and through the coding transition to 2016 (4.8/1000; p < 0.001). This trend was entirely accounted for by injuries made during open surgery, with decreasing injury rates for MIS over time. Adjusted odds ratio (OR) for ureteral injury with all MIS vs. open cases was 0.81 (95% CI 0.70-0.93, p = 0.003) and for robotic-assisted surgery alone versus open cases was 0.50 (95% CI 0.33-0.77, p = 0.001). CONCLUSIONS The incidence rate of ureteral injuries during open colorectal surgery is increasing over time, but have been stable or decreasing for MIS cases. These findings hold even after using propensity score analysis. More research is needed to further delineate the impact of MIS and robotic-assisted surgery on ureteral injuries.
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Affiliation(s)
- John S Mayo
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA.
| | - Miriam L Brazer
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Kenneth J Bogenberger
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Kelli B Tavares
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Robert J Conrad
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Michael B Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA
| | - Suzanne M Gillern
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Chan W Park
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Carly R Richards
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
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Iatrogenic Ureteral Injury and Prophylactic Stent Use in Veterans Undergoing Colorectal Surgery. J Surg Res 2021; 265:272-277. [PMID: 33964637 DOI: 10.1016/j.jss.2021.03.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Iatrogenic ureteral injury (IUI) is an uncommon complication in colorectal surgery. Prophylactic ureteral stenting (PUS) gained acceptance to aid in intraoperative identification of the ureter. Despite its use, the benefit of pus to avoid IUI remains debatable. We sought to analyze the rates of IUI after colorectal surgery in veterans and to compare the outcomes after PUS using a large matched cohort. METHODS The veterans affairs surgical quality improvement program database was queried for patients who underwent colorectal surgery from 2008-2015. To analyze the outcomes of PUS, we created two matched groups using propensity-score matching accounting for demographical and clinical cofactors to assess variable outcomes. Cross-tabulation was used to calculate rates of IUI and univariate and multivariate analyses were performed to evaluate risk factors associated with IUI. RESULTS 27,448 patients were identified and 458 underwent PUS placement (1.6%). The majority of procedures were performed electively and with an open approach. Mean age was 65 y, 96.3% were male, and colorectal cancer was the most common indication. 45 patients (0.2%) were diagnosed with IUI. IUI incidence was higher in female patients, after left-sided colorectal resection, and in those undergoing open procedures. After matching, PUS use was associated with longer length of stay and operative time and increased creatinine levels from baseline. CONCLUSION We demonstrated that the use of PUS is independently associated with increased operative time and change in creatinine levels. Although no IUI occurred in the PUS group, this finding was not statistically significant. The risk and/or benefit ratio of PUS should be considered for each individual case, with its selective use based on the presence of risk factors for IUI, such as female patients and left-sided resections.
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Teste B, Rullier E. Intraoperative complications during laparoscopic total mesorectal excision. Minerva Surg 2021; 76:332-342. [PMID: 33944516 DOI: 10.23736/s2724-5691.21.08691-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative complication during laparoscopic mesorectal excision for rectal cancer is a common complication occurring in 11% to 15% of the cases. They are probably underestimated because not systematically reported. The most frequent intraoperative complications are haemorrhage (3-7%), tumour perforation (1-4%), bowel injury (1-3%), ureter injury (1%), urogenital injury (2%), other organ injury (<1%), and anastomotic complications (1%). The mechanisms, management and prevention of vascular port injury, inferior mesenteric artery bleeding, small bowel and colon perforation, ureteral and urethral injury, pelvic nerve damage, tumour perforation and anastomotic failure are described. This review underlines the necessity to prevent intraoperative complication to avoid operative death and severe side-effects.
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Affiliation(s)
- Blanche Teste
- Department of Colorectal Surgery, Haut-Levèque Hospital, University of Bordeaux, Pessac, France
| | - Eric Rullier
- Department of Colorectal Surgery, Haut-Levèque Hospital, University of Bordeaux, Pessac, France -
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49
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Fan X, Li Y, Feng Z, Chen G, Zhou J, He M, Wu L, Li S, Qian J, Lin H. Nanoprobes-Assisted Multichannel NIR-II Fluorescence Imaging-Guided Resection and Photothermal Ablation of Lymph Nodes. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2003972. [PMID: 33977058 PMCID: PMC8097375 DOI: 10.1002/advs.202003972] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/13/2021] [Indexed: 05/22/2023]
Abstract
Lymph node metastasis is a major metastatic route of cancer and significantly influences the prognosis of cancer patients. Radical lymphadenectomy is crucial for a successful surgery. However, iatrogenic normal organ injury during lymphadenectomy is a troublesome complication. Here, this paper reports a kind of organic nanoprobes (IDSe-IC2F nanoparticles (NPs)) with excellent second near-infrared (NIR-II) fluorescence and photothermal properties. IDSe-IC2F NPs can effectively label lymph nodes and helped achieve high-contrast lymphatic imaging. More importantly, by jointly using IDSe-IC2F nanoparticles and other kinds of nanoparticles with different excitation/emission properties, a multichannel NIR-II fluorescence imaging modality and imaging-guided lymphadenectomy is proposed. With the help of this navigation system, the iatrogenic injury can be largely avoided. In addition, NIR-II fluorescence imaging-guided photothermal treatment ("hot" strategy) can ablate those metastatic lymph nodes which are difficult to deal with during resection ("cold" strategy). Nanoprobes-assisted and multichannel NIR-II fluorescence imaging-guided "cold" and "hot" treatment strategy provides a general new basis for the future precision surgery.
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Affiliation(s)
- Xiaoxiao Fan
- Department of General SurgerySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310000P. R. China
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Yirun Li
- Department of General SurgerySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310000P. R. China
| | - Zhe Feng
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Guoqiao Chen
- Department of General SurgerySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310000P. R. China
| | - Jing Zhou
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Mubin He
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Lan Wu
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Shengliang Li
- College of Pharmaceutical SciencesSoochow UniversitySuzhou215123P. R. China
- Center of Super‐Diamond and Advanced Films (COSDAF)Department of ChemistryCity University of Hong Kong83 Tat Chee AvenueKowloonHong Kong999077P. R. China
| | - Jun Qian
- Department of General SurgerySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310000P. R. China
- State Key Laboratory of Modern Optical InstrumentationsCentre for Optical and Electromagnetic ResearchCollege of Optical Science and EngineeringInternational Research Center for Advanced PhotonicsZhejiang UniversityHangzhou310058P. R. China
| | - Hui Lin
- Department of General SurgerySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310000P. R. China
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50
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Hird AE, Nica A, Coburn NG, Kulkarni GS, Nam RK, Gien LT. Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta-analysis. Colorectal Dis 2021; 23:1060-1070. [PMID: 33340227 DOI: 10.1111/codi.15498] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
AIM Cystoscopic placement of ureteric stents during colorectal surgery (CRS) may aid in the intraoperative identification of the ureters and thus prevent ureteric injury, but may also be associated with prolonged operating time, increased cost and adverse events. No formal recommendations exist regarding the use of ureteric stents prior to CRS. Our aim was to determine the effect of prophylactic ureteric stent insertion on the risk of ureteric injury among adult patients undergoing CRS. METHOD A systematic search using the Ovid platform was completed. The primary outcome was risk of ureteric injury. Secondary outcomes included the risk of acute kidney injury (AKI), urinary tract infection (UTI), sepsis, length of stay (LOS) and mortality. The Paule-Mandel pooling and a random effects model was used to produce odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes. Standardized mean differences (MD) were reported for continuous variables. Analyses were completed using R3.5. RESULTS Nine retrospective cohort studies evaluating 98 507 patients were included. The incidence of ureteric injury was 0.6%. Overall, 5.1% of patients underwent ureteric stenting. There was no change in the odds of ureteric injury among stented patients compared with controls (OR 1.30, 95% CI 0.39-4.29, I2 = 25%). Operating time was significantly longer (MD 49.3 min, 95% CI 35.3-63.4, I2 = 96%) in the intervention group. There was no difference in rates of AKI, UTI, sepsis, LOS or mortality between groups. CONCLUSION Given the retrospective nature of the identified studies, the benefit of prophylactic ureteric stenting remains uncertain. Prophylactic ureteric stenting was not associated with increased patient morbidity but did significantly increase operating time.
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Affiliation(s)
- Amanda E Hird
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andra Nica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Gynecologic Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Girish S Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lilian T Gien
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Gynecologic Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
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