Transnephrostomic ICG Guided Robotic Ureretal Reimplantation for Ureteroileal Strictures after Robotic Cystectomy and Neobladder: step by step technique

Giuseppe Simone1, Gabriele Tuderti1, Leonardo Misuraca1, Mariaconsiglia Ferriero1, Francesco Minisola1, Giulio Vallati2, Salvatore Guaglianone1, Michele Gallucci1
  • 1 Istituto Nazionale Tumori "Regina Elena", Unità di Urologia (Roma)
  • 2 Istituto Nazionale Tumori "Regina Elena", Unità di Radiologia (Roma)


INTRODUCTION: In this video we describe our initial experience with robotic ureteral reimplantation for uretero-enteric anastomotic strictures in patients previously treated with robot assisted radical cystectomy and intracorporeal neobladders (RARC-N) with the use of near infrared fluorescence (NIRF) imaging after transnephrostomic injection of indocyanine green (ICG).
METHODS: From April 2015 to October 2017, 9 consecutive patients underwent robotic ureteral reimplantation in one tertiary referral center. All patients previously underwent RARC-N with the same standardized technique.
All patients previously underwent percutaneous nephrostomy and at least one antegrade stenting and stricture dilatation attempt.
This was a case of a 64 year old male, with a 2.5 centimeters left ureteral stricture, who underwent RARC-N 10 months ago.
As shown in the video, transnephrostomic injection of ICG was performed to identify the lumbar ureter.
Intravenous ICG was injected and allowed to easily identify the left iliac artery.
RESULTS: Median time from RARC to uretero-anastomotic stricture diagnosis was 5mo (IQR2-6). Median stricture length was 1,5 cm (IQR 1-2). Median operative time was 140 minutes (IQR 81-155) and median length of stay was 5 days (IQR 3-9).
All cases were completed robotically.
CONCLUSIONS:Near infrared fluorescence imaging provides an easy guide to identify and progressively dissect the ureter.