Skip to main content
SpringerLink
Log in

Ureter Identification Using Methylene Blue and Fluorescein

  • Chapter
Fluorescence Imaging for Surgeons

Abstract

The use of a multimodal optical system that expands the surgeon’s light spectrum of view can improve surgical performance making structures clearly visible during laparoscopic and open surgery. This allows for shorter procedural duration and improved prevention and incidence of ureteral injury associated with complex pelvic surgery. Optical imaging using invisible NIR fluorescent light has several advantages over currently available intraoperative techniques. First, visualization of the ureters does not require ionizing radiation, and uses only safe wavelengths of light for ample excitation. Secondly, because fluorescence emission is invisible to the human eye, the surgical field is not stained or changed in any way. The blue dyes that are currently used stain the surgical field and have relatively poor contrast. Thirdly, imaging can be performed in real-time (up to 15 frames per second) with the merged image from the color video and NIR fluorescent cameras providing anatomical landmarks that are easily identifiable. More work is needed to identify the optimal contrast agent and light wavelength with which it is most optimally visualized. Overall, this field of knowledge is of great interest and reports a great growing potential.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Park S, Pearle MS. Imaging for percutaneous renal access and management of renal calculi. Urol Clin North Am. 2006;33:353–64.

    Article  PubMed  Google Scholar 

  2. Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv. 2003;58(12):794–9.

    Article  PubMed  Google Scholar 

  3. Bothwell WM, Cathcart KS, Bombardt PA. An on-line, column-switching high-performance liquid chromatographic procedure for the removal of probenecid from human plasma, serum, or urine in the quantitative determination of cefmetazole or cefoxitin. J Pharm Biomed Anal. 1989;7:987–95.

    Article  CAS  PubMed  Google Scholar 

  4. Kuno K, Menzin A, Kauder HH, Sison C, Gal D. Prophylactic ureteral catheterization in gynecologic surgery. Urology. 1998;52:1004–8.

    Article  CAS  PubMed  Google Scholar 

  5. Parpala-Spårman T, Paananen I, Santala M, Ohtonen P, Hellström P. Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol. 2008;42(5):422–7.

    Article  PubMed  Google Scholar 

  6. Wang AC. The techniques of trocar insertion and intraoperative rethrocystoscopy in tension-free vaginal taping: an experience of 600 cases. Acta Obstet Gynecol Scand. 2004;83:293–8.

    Article  PubMed  Google Scholar 

  7. Visco AG, Taber KH, Weidner AC, Barber MD, Myers ER. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol. 2001;97:685–92.

    Article  CAS  PubMed  Google Scholar 

  8. Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N’Dow J. Ureteric injury: a challenging condition to diagnose and manage. Nat Rev Urol. 2013;10(2):108–15.

    Article  PubMed  Google Scholar 

  9. Meirow D, Moriel EZ, Zilberman M, Farkas A. Evaluation and treatment of iatrogenic ureteral injuries during obstetric and gynecologic operations for nonmalignant conditions. J Am Coll Surg. 1994;178:144–8.

    CAS  PubMed  Google Scholar 

  10. Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol. 1996;155:878–81.

    Article  CAS  PubMed  Google Scholar 

  11. Redan JA, McCarus SD. Protect the ureters. JSLS. 2009;13(2):139–41.

    PubMed Central  PubMed  Google Scholar 

  12. Siddighi S, Carr KR. Lighted stents facilitate robotic-assisted laparoscopic ureterovaginal fistula repair. Int Urogynecol J. 2013;24(3):515–7.

    Article  PubMed  Google Scholar 

  13. Kusaka J, Matsumoto S, Hagiwara S, Koga H, Noguchi T. Use of perioperative ureteral stent in abdominal aortic aneurysm with retroperitoneal fibrosis - a report of two cases. Kr J Anesthesiol. 2012;63(1):76–9.

    Article  Google Scholar 

  14. Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM. Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg. 2012;147(3):267–71.

    Article  PubMed  Google Scholar 

  15. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum. 2004;47(10):1680–5.

    Article  PubMed  Google Scholar 

  16. Cahill RA, Ris F, Mortensen NJ. Near-infrared laparoscopy for real-time intra-operative arterial and lymphatic perfusion imaging. Colorectal Dis. 2011;13 Suppl 7:12–7.

    Article  PubMed  Google Scholar 

  17. Matsui A, Tanaka E, Choi HS, Kianzad V, Gioux S, Lomnes SJ, Frangioni JV. Real-time, near-infrared, fluorescence-guided identification of the ureters using methylene blue. Surgery. 2010;148(1):78–86.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Tanaka E, Ohnishi S, Laurence RG, Choi HS, Humblet V, Frangioni JV. Real-time intraoperative ureteral guidance using invisible near-infrared fluorescence. J Urol. 2007;178(5):2197–202.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Verbeek FP, van der Vorst JR, Schaafsma BE, Swijnenburg RJ, Gaarenstroom KN, Elzevier HW, van de Velde CJ, Frangioni JV, Vahrmeijer AL. Intraoperative near infrared fluorescence guided identification of the ureters using low dose methylene blue: a first in human experience. J Urol. 2013;190(2):574–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Cahill RA, Mortensen NJ. Intraoperative augmented reality for laparoscopic colorectal surgery by intraoperative near-infrared fluorescence imaging and optical coherence tomography. Minerva Chir. 2010;65(4):451–62.

    CAS  PubMed  Google Scholar 

  21. Gioux S, Kianzad V, Ciocan R, Gupta S, Oketokoun R, Frangioni JV. High power, computer-controlled, LED-based light sources for fluorescence imaging and image-guided surgery. Mol Imaging. 2009;8:156–65.

    PubMed Central  CAS  PubMed  Google Scholar 

  22. Troyan SL, Kianzad V, Gibbs-Strauss SL, Gioux S, Matsui A, Oketokoun R, et al. The FLARE™ intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol. 2009;16:2943–52.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Khan MA, North AP, Chadwick DR. Prolonged postoperative altered mental status after methylene blue infusion during parathyroidectomy: a case report and review of the literature. Ann R Coll Surg Engl. 2007;89(2):W9–11.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Frangioni JV. In vivo near-infrared fluorescence imaging. Curr Opin Chem Biol. 2003;7:626–34.

    Article  CAS  PubMed  Google Scholar 

  25. Lee Z, Simhan J, Parker DC, Reilly C, Llukani E, Lee DI, Mydlo JH, Eun DD. Novel use of indocyanine green for intraoperative, real-time localization of ureteral stenosis during robot-assisted ureteroureterostomy. Urology. 2013;82:729–33.

    Article  PubMed  Google Scholar 

  26. Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, Fine SL. Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology. 1991;98:1139–42.

    Article  CAS  PubMed  Google Scholar 

  27. Jennings BJ, Mathews DE. Adverse reactions during retinal fluorescein angiography. J Am Optom Assoc. 1994;65:465–71.

    CAS  PubMed  Google Scholar 

  28. Gómez-Ulla F, Gutiérrez C, Seoane I. Severe anaphylactic reaction to orally administered fluorescein. Am J Ophthalmol. 1991;112:94.

    Article  PubMed  Google Scholar 

  29. Udshmadshuridze NS, Asikuri TO. Intra-operative imaging of the ureter with sodium fluorescein. Z Urol Nephrol. 1988;81(10):635–9.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of General and Vascular Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Fernando D. Dip M.D., M.A.A.C., Sandy Perrins M.D. & Raul J. Rosenthal M.D., F.A.C.S.

  2. Oncological Surgical Division, Division of Surgical Research, Department of Surgery, Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Fernando D. Dip M.D., M.A.A.C.

  3. Department of Colorectal Surgery, Hospital de Clinicas Jose de San Martin, 2354 Cordoba Ave., 7th Floor, Office 1, Caba, Buenos Aires, 1026, Argentina

    Alejandro Daniel Moreira Grecco M.D.

  4. Section of Surgery, Department of General Surgery, Hospital de Clinicas Jose de San Martin, 2351 CĂłrdoba Ave., Ciudad AutĂłnoma de Buenos Aires, Buenos Aires, C112OAAR, Argentina

    David Nguyen M.D. & Luis Sarotto M.D.

Authors
  1. Fernando D. Dip M.D., M.A.A.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro Daniel Moreira Grecco M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Nguyen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis Sarotto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandy Perrins M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raul J. Rosenthal M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando D. Dip M.D., M.A.A.C. .

Editor information

Editors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of General and Vascular Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, FL, USA; Oncological Surgical Division, Division of Surgical Research, Department of Surgery, Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Fernando D. Dip

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Takeaki Ishizawa

  3. Hepato-Biliary-Pancreatic Surgery; Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Norihiro Kokudo

  4. Department of General Surgery, Section of Minimally Invasive Surgery; Department of General and Vascular Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida, USA

    Raul J. Rosenthal

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Dip, F.D., Moreira Grecco, A.D., Nguyen, D., Sarotto, L., Perrins, S., Rosenthal, R.J. (2015). Ureter Identification Using Methylene Blue and Fluorescein. In: Dip, F., Ishizawa, T., Kokudo, N., Rosenthal, R. (eds) Fluorescence Imaging for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-319-15678-1_35

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15678-1_35

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15677-4

  • Online ISBN: 978-3-319-15678-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation