Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Surgery, John Radcliffe Hospital, Headley Way, Headington, OX3 9DS, UK.
Tech Coloproctol. 2017 Jun;21(6):439-444. doi: 10.1007/s10151-017-1615-y. Epub 2017 May 30.
Urethral injury is a complication feared by surgeons performing transanal TME (TaTME) or abdominoperineal excision (APE) procedures. Injury during TaTME occurs when the prostate is inadvertently mobilised or as a direct injury similar to the direct injury during the perineal dissection of APE procedures. We performed a proof of principle study to assess the feasibility of using indocyanine green (ICG) to fluoresce the urethra in human cadavers.
Indocyanine green at varying doses was mixed with Instillagel and infiltrated into the urethra of male human cadavers. The urethra was exposed through either a perineal incision or by mobilisation of the prostate during a TaTME dissection and fluorescence observed using a PINPOINT laparoscope (NOVADAQ). Brightness was assessed on the images using ImageJ (National Institute of Health).
Eight cadavers were included in the study. Fluorescence was visualised in the urethra in all eight cadavers. Minimal dissection was required to obtain fluorescence transperineally. In one cadaver, the urethra was demonstrated under fluorescence using a simulated TaTME with additional fluorescence also being observed in the prostate. There was no correlation between brightness and dosing.
This novel proof of principle study demonstrates a simple way in which the urethra may be easily identified preventing it from injury during surgery.
尿道损伤是行经肛门全直肠系膜切除术（TaTME）或腹会阴切除术（APE）的外科医生所担心的并发症。TaTME 术中前列腺意外活动或直接损伤时会发生损伤，类似于 APE 手术会阴切开时的直接损伤。我们进行了一项原理验证研究，以评估使用吲哚菁绿（ICG）荧光标记尿道在人体尸体中的可行性。
将不同剂量的吲哚菁绿与 Instillagel 混合并注入男性人体尸体的尿道中。通过会阴切口或 TaTME 解剖过程中前列腺的移动暴露尿道，并使用 PINPOINT 腹腔镜（NOVADAQ）观察荧光。使用 ImageJ（美国国立卫生研究院）评估图像的亮度。
本研究纳入了 8 具尸体。在所有 8 具尸体中均可见尿道荧光。经会阴获得荧光所需的解剖量最小。在一具尸体中，通过模拟 TaTME 显示了荧光下的尿道，并且还观察到前列腺中的荧光。亮度与剂量之间无相关性。
这项新颖的原理验证研究证明了一种简单的方法，可以轻松识别尿道，防止手术中损伤。
