MP65-19: Open field near-infrared fluorescence angiography is a useful tool to assess tissue integrity in complex, open, genitourinary reconstructive surgery
Introduction: Genitourinary reconstructive surgery frequently involves high-risk patient populations with compromised tissue perfusion – a risk factor for poor reconstructive outcomes. Traditionally, intraoperative tissue viability characterization relies on direct and subjective surgeon assessment. Intravascular indocyanine green (ICG) combined with open field near-infrared fluorescence (NIRF) imaging enables objective quantification of tissue perfusion and viability. Herein, we sought to compare open subjective intraoperative surgeon and objective ICG angiography assessment in radiated patients undergoing complex urologic reconstruction. Methods: A retrospective single surgeon review of 39 patients (40 surgeries) in which SPY-PHI (Stryker Kalamazoo, MI) was utilized during open, complex genitourinary reconstructive surgery between June 2018 and April 2022. Differences in altered surgical decision making, ureteral perfusion characteristics, complications, and reconstructive success were assessed. Results: There were 39 patients with a median age of 66 who underwent 40 multimodality reconstructive surgeries during which open ICG angiograpy was utilized with median follow-up 23.4 months. Surgery was performed for radiation induced complications in 32 of 40 (80%). Among patients with documentation of ureteral length evaluation (N=16), median subjective vs objective assessment of poor distal perfusion was 1.8 cm vs 3.2 cm (p=0.001). In total, discordance in perfusion assessment was noted in 19(61%) of ureters. In 25 (63%) cases, use of ICG angiography influenced intraoperative surgical decision making. ICG angiography was significantly more likely to impact surgical decision making in radiated vs non-irradiated cases (23(72%) vs 1 (13%); p=0.007). There was 1 complication in the non-irradiated cohort and 12 complications in the radiated cohort. At a median follow-up of 23 months, 1 (3%) patient in the radiation cohort developed a ureteroenteric anastomotic stricture. Conclusions: Among patients with radiation injury undergoing complex open urinary reconstruction, utilization of ICG angiography revealed a high-level of operative discordance compared to subjective surgeon assessment and ultimately influenced surgical decision making. Reassuring reconstructive outcomes noted in this population would suggest that ICG angiography is a useful tool in complex open genitourinary reconstructive surgery. SOURCE OF Funding: None
