Journal
COLORECTAL DISEASE
Volume 22, Issue 11, Pages 1749-1753Publisher
WILEY
DOI: 10.1111/codi.15156
Keywords
Fluorescene imaging; fluorescence imaging guided surgery; near-infrared; urethra injury; transanal surgery; colorectal cancer
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Funding
- ARC Foundation for Cancer
- Society to Accelerate Tech Transfer (SATT) Conectus Alsace
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Aim Transanal total mesorectal excision is a promising novel sphincter-saving procedure for low rectal cancer. However, the transanal bottom-up dissection is associated with increased rates of iatrogenic urethral injuries. Near-infrared fluorescence (NIRF) imaging, given its deeper tissue penetration, has been explored in a limited number of studies for enhanced intra-operative urethral visualization. In this study, we explored the feasibility of a novel, ultrabright, biocompatible fluorescent polymer to coat urinary catheters for the purpose of intra-operative urethral visualization. Methods In an ex vivo experiment, using a near-infrared laparoscope, the fluorescent signal of a coated catheter (near-infrared coating of equipment, NICE) was qualitatively and quantitatively compared to the signal of indocyanine green (ICG)/Instillagel (R) mixtures and ICG-filled catheters at several concentrations. Also, in three male human torsos, using fluorescent urinary catheters, NIRF-guided perineal dissections and a transanal total mesorectal excision were performed. Intra-operative NIRF-based urethral visualization was performed systematically. Results During the qualitative and quantitative fluorescence signal assessment, NICE-coated catheters were clearly superior to the ICG-based solutions. In the cadaveric experiments, enhanced urethral visualization was possible even at early stages of dissection, when the organ was covered by several tissue layers. Conclusions NICE-coated catheters represent a promising potential to allow for NIRF-based intra-operative urethral visualization.
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