Indocyanine Green Fluorescence Imaging For Laparoscopic Complex Upper Urinary Tract Reconstructions: A Comparative Study

Background: To describe our technique for using an intraureteral injection of indocyanine green (ICG) and visualization under near-infrared fluorescence (NIRF) to facilitate challenging upper urinary tract reconstructions (UUTRs) and to present the comparative outcomes.Methods: We collected 36 patients who underwent laparoscopic UUTRs between April 2019 and March 2020, and we divided the patients into two groups based on the use of ICG (ICG group and non-ICG group). Demographic characteristics, perioperative outcomes, and functional outcomes were compared between the two groups.Results: There were 18 cases in the ICG group and 18 cases in the non-ICG group, respectively. There were no differences in the baseline characteristics between the two groups. The intraoperative time to identification of the ureter (TIU; 20.9 +/- 11.7 vs. 30.0 +/- 14.6 min, P=0.03) and length of postoperative hospital stay (LPHS; 11.1 +/- 3.0 vs. 16.6 +/- 10.0 days, P=0.03) were significantly shorter in the ICG group. There was also a trend for lesser time for locating the stricture (43.0 +/- 27.9 vs. 55.4 +/- 18.6 min, P=0.14) and lower estimated blood loss (EBL) in the ICG group patients (88.3 +/- 75.4 vs. 91.7 +/- 46.2 mL, P=0.22). During the mean 3.8-month follow-up for the ICG group and the 6.2-month for the non-ICG group, there was a trend for more severe complications in the non-ICG group.Conclusions: Visualizing intraureteral ICG under NIRF is useful in challenging UUTRs, allows for rapid ureteral identification and accurate real-time delineation of the ureteral stricture margins, and provides encouraging follow-up outcomes compared with those in the non-ICG group.