Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience
2013; Lippincott Williams & Wilkins; Volume: 190; Issue: 2 Linguagem: Inglês
10.1016/j.juro.2013.02.3187
ISSN1527-3792
AutoresF.P.R. Verbeek, Joost R. van der Vorst, Boudewijn E. Schaafsma, Rutger‐Jan Swijnenburg, Katja N. Gaarenstroom, Henk W. Elzevier, Cornelis J. H. van de Velde, John V. Frangioni, Alexander L. Vahrmeijer,
Tópico(s)Abdominal Surgery and Complications
ResumoNo AccessJournal of UrologyAdult Urology1 Aug 2013Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience Floris P.R. Verbeek, Joost R. van der Vorst, Boudewijn E. Schaafsma, Rutger-Jan Swijnenburg, Katja N. Gaarenstroom, Henk W. Elzevier, Cornelis J.H. van de Velde, John V. Frangioni, and Alexander L. Vahrmeijer Floris P.R. VerbeekFloris P.R. Verbeek Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Joost R. van der VorstJoost R. van der Vorst Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Boudewijn E. SchaafsmaBoudewijn E. Schaafsma Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Rutger-Jan SwijnenburgRutger-Jan Swijnenburg Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Katja N. GaarenstroomKatja N. Gaarenstroom Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Henk W. ElzevierHenk W. Elzevier Department of Urology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Cornelis J.H. van de VeldeCornelis J.H. van de Velde Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , John V. FrangioniJohn V. Frangioni Department of Radiology, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts Financial interest and/or other relationship with the FLARE™ Foundation, Curadel, Curadel Medical Devices and Curadel In Vivo Diagnostics. More articles by this author , and Alexander L. VahrmeijerAlexander L. Vahrmeijer Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3187AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Near infrared fluorescence imaging is a promising technique that offers real-time visual information during surgery. In this study we report the first clinical results to our knowledge of ureteral imaging using near infrared fluorescence after a simple peripheral infusion of methylene blue. Furthermore, we assessed the optimal timing and dose of methylene blue. Materials and Methods: A total of 12 patients who underwent lower abdominal surgery were included in this prospective feasibility study. Near infrared fluorescence imaging was performed using the Mini-FLARE™ imaging system. To determine optimal timing and dose, methylene blue was injected intravenously at doses of 0.25, 0.5 or 1 mg/kg after exposure of the ureters. Imaging was performed for up to 60 minutes after injection. Results: In all patients both ureters could be clearly visualized within 10 minutes after infusion of methylene blue. The signal lasted at least up to 60 minutes after injection. The mean signal-to-background ratio of the ureter was 2.27 ± 1.22 (4), 2.61 ± 1.88 (4) and 3.58 ± 3.36 (4) for the 0.25, 0.5 and 1 mg/kg groups, respectively. A mixed model analysis was used to compare signal-to-background ratios among dose groups and times, and to assess the relationship between dose and time. A significant difference among time points (p <0.001) was found. However, no difference was observed among dose groups (p = 0.811). Conclusions: This study demonstrates the first successful use of near infrared fluorescence using low dose methylene blue for the identification of the ureters during lower abdominal surgery. References 1 : Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol1996; 155: 878. Link, Google Scholar 2 : Urinary tract injuries: recognition and management. Clin Colon Rectal Surg2010; 23: 221. Google Scholar 3 : Prophylactic ureteral catheterization in gynecologic surgery. Urology1998; 52: 1004. 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Volume 190Issue 2August 2013Page: 574-579Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsuretermolecular imagingfluorescenceurologymethylene blueAcknowledgmentsDavid Burrington provided assistance.MetricsAuthor Information Floris P.R. Verbeek Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Joost R. van der Vorst Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Boudewijn E. Schaafsma Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Rutger-Jan Swijnenburg Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Katja N. Gaarenstroom Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Henk W. Elzevier Department of Urology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Cornelis J.H. van de Velde Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author John V. Frangioni Department of Radiology, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts Financial interest and/or other relationship with the FLARE™ Foundation, Curadel, Curadel Medical Devices and Curadel In Vivo Diagnostics. More articles by this author Alexander L. Vahrmeijer Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Expand All Advertisement PDF downloadLoading ...
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