VM47 - Ureteral Identification in Abdominopelvic Reoperation Surgeries Using Near-infrared Fluorescence (NIR-F) Imaging

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Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Katherine Lam, MD

Clinical Research Resident
Ichan School of Medicine at Mount Sinai
YONKERS, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

HS

Hannah Son, Bachelors of Science

Clinical Research Assistant
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
VY

Victoria Yuan, MD

General Surgery Resident
New York Presbytarian Queens
NYC, New York, United States

Disclosure information not submitted.
RM

Roxanne Mistry, BA

Clinical Research Coordinator
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
SS

Sophia Sinins, BA

Clinical Research Coordinator II
Mount Sinai Hospital
New York, New York, United States

Disclosure information not submitted.
Katherine F. Donovan, MD (she/her/hers)

resident
Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai Hospital
New York City, New York, United States

Disclosure information not submitted.
SH

Sue J. Hahn, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York City, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Sergey Khaitov, MD

Associate Professor of Surgery
Icahn School of Medicine at Mount Sinai
New York City, New York, United States

Disclosure information not submitted.

Senior Author(s)

Patricia Sylla, MD (she/her/hers)

System Chief of Colon and Rectal Surgery
Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai
New York City, NY, United States

All of the relevant financial relationships listed below have been mitigated.
Activ Surgical: Consultant (Ongoing); Ethicon: Consultant (Ongoing); Exero: Consultant (Ongoing); Safeheal: Consultant (Ongoing); Stryker: Consultant (Ongoing)

All of the relevant financial relationships listed below have been mitigated.

Katherine Lam, MD: This individual has no financial relationships with ineligible companies.

Sue J. Hahn, MD: This individual has no financial relationships with ineligible companies.

Patricia Sylla, MD: Activ Surgical: Consultant (Ongoing); Ethicon: Consultant (Ongoing); Exero: Consultant (Ongoing); Safeheal: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Image or Table (Do Not add text here):

Purpose/Background: Iatrogenic ureteral injury during colorectal surgery is rare. It is estimated to be 0.3-1.5%. However, the risk increases to 10% with risk factors such as altered anatomy, prior surgeries, radiation, and extensive pelvic diseases. The need for ureteral visualization during abdominopelvic surgery is increasingly important. Although the utilization of intraoperative near-infrared fluorescence (NIR-F) imaging helps identify ureter, currently, to visualize the ureters, cystoscopy and ureteral stents are required for indocyanine green (ICG) fluorescence retrograde administration. We describe the use of NIR-F imaging in combination with an investigational agent as part of a clinical trial, that was given intravenously to assist with ureteral identification during complex pelvic reoperation without ureteral stents or catheter.

Methods/Interventions: The investigational agent in use was ASP 5354 (known as pudexacianinium chloride), a novel NIR-F imaging agent, under investigation for intraoperative anatomical identification and visualization of ureter. Unlike ICG, ASP 5354 is administered intravenously and has clinically distinct pharmacokinetic profile that allows ASP 5354 to be excreted into the urine through the kidneys. Photo-optically, ASP 5354 is indistinguishable from ICG, with an absorption of 780 nm and a fluorescence emission at 820 nm, allowing for the use of approved (ICG) NIR-F imaging technology. The NIR-F imaging technology when used with ASP5354 facilitates anatomic ureter visualization.

Results/Outcomes: The case presentation was a 59 year old male with a history of upper rectal cancer cT3N1aM0. He received neoadjuvant treatment, chemoradiation, underwent laparoscopic LAR with DLI and a subsequent loop ileostomy closure. Two years after initial LAR, his PET/CT showed increased left perirectal lymph nodes activity. Pelvic MRI and biopsy from colonoscopy confirmed local recurrence of rectal adenocarcinoma. The operative plan was to redo laparoscopic LAR with transanal TME and DLI, while visualizing the ureters with ASP 5354 under NIR-F imaging. The surgery was carried out successfully without ureteral injuries, and avoided the use of ureteral stenting.

Conclusion/Discussion: The near-infrared fluorescence (NIR-F) imaging in combination with the intravenous investigation agent ASP 5354 for ureteral visualization can be useful in both minimally invasive and open surgeries. The ability to have NIR-F imaging with white light helps with dissection in real time in complex reoperative cases. Not only does this type of imaging help avoid ureteral stenting, it also shows promising potential in future image-guided surgery.