Introduction: Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) is increasingly being explored in various urological procedures, including urethral reconstructive surgery. This real-time technology assists surgeons in the visualization of critical anatomical structures, thereby potentially improving surgical precision and patient outcomes.
Objective: This study aimed to report our preliminary experience using ICG technology in urethral reconstructive surgery using the SPY system by Novadaq.
Materials and Methods: ICG technology was adopted in seven urethral reconstructive procedures performed in Saiful Anwar Hospital over 1 month. The procedures were performed by two surgeons, consisting of five excisions and primary anastomosis (EPA) and two substitution urethroplasties with real-time evaluation of ICG expression in corpus spongiosum intraoperatively. Result The ICG solution was injected intravenously in all urethral reconstructive procedures. The ICG injection was allowed to visualize the corpus spongiosum in a matter of 30–60 s. The dosage of ICG used was 5 mg diluted in 10 mL of normal saline. One procedure had been converted from EPA to vascular-sparring anastomotic urethroplasty because of poor perfusion of the corpus spongiosum. All the procedures had good outcomes. No adverse and allergic reactions to ICG and other complications occurred postoperatively.
Conclusion: Our preliminary experience confirmed the safety and efficacy of ICG technology in urethral reconstructive surgery. The main advantage of using NIRF imaging is allowing the surgeon to real-time evaluate corpus spongiosum qualitatively and quantitatively. The limitation is specific equipment needed like the SPY system by Novadaq.
