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67th Annual Meeting Abstracts
Fluorescence Optical Imaging of Ureters: A Pilot Feasibility Study
Edouard J Trabulsi1, *Norman Rosenblum2, *Rafay Ahmed2, *Flemming Forsberg2, *Shumin Wang2, Leonard G Gomella1, *Barry B Goldberg2, *Ji-Bin Liu2
1Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA;2Thomas Jefferson University, Philadelphia, PA
Objective: To test the feasibility of fluorescence-enhanced optical imaging associated with intravenous methylene blue to assist in the intraoperative visualization of ureters.
Methods: Ten patients undergoing open abdominal surgery were enrolled. Real-time fluorescent images of distal ureters were acquired with an investigational Fluorescence Guided Surgery (FiGS) system (GE Healthcare, Milwaukee, WI) after intravenous injection of 1% Methylene blue (2 mg/kg). The ability to identify the ureteral segments, with and without fluorescence-enhanced optical imaging, was visually scored and assessed independently by 2 reviewers for visual conspicuity at 2 different time points on a 5-point scale (1 to 5; worst to best). The duration of contrast enhancement was determined. A non-parametric, Wilcoxon signed-rank test was used to compare the results with and without fluorescent dye.
Results: A total of 20 ureters were evaluated with and without fluorescent imaging. Real-time fluorescent imaging clearly demonstrated dye-enhanced distal ureters with peristalsis. Mean score was 2.4±1.71 for reviewer 1 and 2.4±1.57 for reviewer 2 on non-fluorescence imaging while the mean FiGS score was 3.7±1.70 and 3.5±1.77 for reviewers 1 and 2. There was a trend toward significance for higher FiGS scores compared to regular images (p<0.08). There were no differences between the scores of the reviewers (p>0.15). There were 4 ureters not visualized by fluorescent imaging due to overlaying inflammatory tissue or lesions (endometriosis). The duration of the positive enhancement exceeded 120 minutes. No complications occurred.
Conclusion: A new fluorescence-based optical imaging technique has the potential for improving the localization of the ureter during intra-abdominal surgery.
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