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Intraoperative Ureteral Identification With Infrared Imaging
Neil Kansal*1, Mehrdad Alemozaffar*1, Nadeem N Dhanani*1, Alex Gorbach*2, Fred Gage*3, Allan Kirk*3, Eric Elster*3, Peter A Pinto1
1Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD;2National Institutes of Health, Bethesda, MD;3NIDDK, National Institutes of Health, Bethesda, MD
Introduction: Iatrogenic ureteral injury during abdominopelvic surgery is a recognized concern for surgeons that becomes more pronounced during laparoscopic surgery given the 2-dimensional visualization and the decreased tactile feedback. Infrared (IR) imaging has the capacity to aid in intraoperative identification of ureters. IR waves correlate to the heat content of the tissue from which they are being emitted and are able to be captured by specialized cameras sensitive to changes as little as 0.1 C. This can than be displayed in real time on video monitors in a variety of gray and color scales.
Methods: Ten Porcine models (50-60kg) were used as analogues for the human urinary tract as they have similar anatomy. Laparotomy was performed with dissection of the renal hilum and identification of the ureter. The ureters were partially transected in order to allow catheterization. Saline boluses of varying temperature were then injected into the ureters under IR imaging in an attempt to visualize them.
Results: The ureters were rapidly and readily visualized with IR imaging in all models. Furthermore, ureteral identification was possible even after placing gauze over the retroperitoneal structures in an attempt to prevent visualization of these structures by visible light.
Conclusions: Infrared imaging offers a promising modality for identifying ureters in the intraoperative setting. With the increasing popularity of minimally invasive surgical techniques, technologies such as this can be an important tool for the surgeon to accurately identify anatomic structures and thus minimize complications and morbidity.
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