A systematic review of clinically available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters during laparoscopic surgery

Abstract

Background: Iatrogenic ureteral injury is a rare but serious complication during laparoscopic abdominopelvic surgery. Preoperative ureteral stent placement can facilitate intraoperative identification of the ureters. However, even with ureteral stents, visualization of ureters during laparoscopic abdominopelvic surgery can be challenging due to their retroperitoneal location and, particularly during robot-assisted surgery, the lack of tactile feedback. Recently, the use of near-infrared (NIR) fluorescence imaging showed to be a good non-invasive alternative for intraoperative ureter identification. The aim of this review is to provide an overview of current clinically available contrast agents for NIR fluorescence imaging of the ureters during laparoscopic surgery and also focuses on novel experimental dyes. Methods: A systematic literature search was performed in the PubMed database. Data were extracted from eligible papers and reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Clinically relevant information focusing on the clinical use of NIR fluorescence imaging for ureter identification during laparoscopic surgery was reviewed. Results: The search identified a total of 149 articles. Of these, 9 articles met our eligibility criteria and formed the basis of this review. The feasibility of two current clinically available contrast agents, methylene blue (MB) and indocyanine green (ICG), and two experimental dyes, ZW800-1 and IS-001, were evaluated for NIR fluorescence imaging of the ureters during laparoscopic abdominopelvic surgery in human. Conclusions: The current clinically available dyes, MB and ICG, are less applicable for NIR fluorescence imaging of the ureters during laparoscopic surgery. Based on their properties, MB is preferred over ICG but has its limitations. ZW800-1, on the other hand, is a promising fluorescent contrast agent for ureter visualization. In the future, larger clinical trials are needed to assess the benefit of intraoperative NIR fluorescence imaging on iatrogenic ureteral injury.