應用吲哚青綠（ICG）之機器人輔助輸尿管再植術治療婦科手術後醫源性遠端輸尿管狹窄：病例報告

吳志緯¹、李秉叡¹、邱文祥^1,2、何承勳¹、黃一勝¹、盧昱成¹、蔡德甫¹、何肇晏^1,2

1.  新光吳火獅紀念醫院外科部泌尿科

2.  國立陽明交通大學醫學院醫學系

Robotic-Assisted Ureteral Replantation Using Indocyanine Green (ICG) for Iatrogenic Distal Ureteral Stricture Following Gynecological Surgery: A Case Report

Chih-Wei Wu¹, Ping-Jui Lee ¹, Allen W. Chiu ^{1, 2}, Chen-Hsun Ho ^1,3, Thomas I.S. Hwang ¹, Yu-Cheng Lu ¹ , Te-Fu Tsai¹, Chao-Yen Ho^{1, 2}  

1.      Divisions of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan;

2.      School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;

Purpose:

Managing iatrogenic ureteral strictures following gynecological surgery remains a formidable challenge, often complicated by dense pelvic adhesions that obscure normal anatomy. While robotic-assisted reconstruction is the standard of care, the antegrade administration of Indocyanine Green (ICG) via a percutaneous nephrostomy (PCN) tube provides a significant advantage. This technique allows for real-time, intraluminal fluorescence, enabling the surgeon to precisely localize the ureter and clearly demarcate the proximal extent of the stricture within a scarred surgical field. In this article, we present a case of ICG-augmented robotic ureteroneocystostomy, demonstrating how this 'roadmap' facilitates safe dissection and ensures an accurate, tension-free reconstruction.

Case:

A 48-year-old woman who had undergone laparoscopic hysterectomy was referred to our urology outpatient department with right-sided loin discomfort 2 weeks postoperatively. Renal ultrasonography was performed and revealed right hydronephrosis. A percutaneous nephrostomy with pigtail catheter placement was subsequently performed for temporary urinary diversion, which was maintained for a further 8 weeks. Further evaluation with computed tomography (CT) demonstrated a stricture of the right ureter. Following detailed discussion with the patient and her family, she consented to undergo robotic-assisted right ureteral reconstruction with intraoperative use of indocyanine green (ICG).

During the procedure, ICG was injected antegradely via the nephrostomy catheter, allowing precise localisation of the stenotic segment under near-infrared fluorescence imaging. Significant peri-ureteral fibrosis was noted intraoperatively. After excision of the diseased ureteral segment, a cystotomy was created at the bladder dome, and a tension-free ureteroneocystostomy was performed. A ureteric stent was inserted retrogradely prior to completion of the anastomosis.

The patient had an uneventful postoperative course and was discharged without complications. Follow-up renal ultrasonography at 4 weeks postoperatively demonstrated improvement in hydronephrosis.

Conclusion:

Intraureteral ICG injection with near-infrared fluorescence imaging facilitated robotic-assisted ureteroneocystostomy by enabling rapid and accurate identification of the stenotic segment. This case suggested that ureteral reconstruction with ICG guidance is a safe and reproducible technique. Further studies with larger cohorts are required to better characterise its efficacy and reproducibility.