Efficacy of the Near-Infrared Ray Fluorescent Ureteral Catheter for Prevention of Transplant Ureteral Injury in Laparoscopic Surgery after Kidney Transplant

Abstract

The increasing adoption of minimally invasive surgery has led to more kidney transplant patients undergoing laparoscopic procedure. However, these surgeries rely heavily on visual feedback due to the lack of tactile sensation, placing the transplanted ureter (located outside the peritoneum) at high risk of iatrogenic injury. The near-infrared ray catheter is a fluorescent ureteral catheter designed to emit light visible under near-infrared irradiation, offering a novel solution for enhancing ureteral visibility. Although its utility has been demonstrated in general abdominal and pelvic surgeries, its application in renal transplant cases remains underreported. In this study, we reviewed our experience with 4 cases of laparoscopic pelvic surgery in kidney transplant recipients: 1 case of lymphocele fenestration and 3 cases of bilateral salpingo-oophorectomy with or without total abdominal hysterectomy. These surgeries posed important challenges because of the anatomical complexity and proximity of the ureter to the surgical field. In each case, the transplanted ureter, barely visible under natural light, was clearly delineated under near-infrared illumination, enabling precise and safe dissection. This approach not only minimized the risk of ureteral injury but also reduced surgical stress and potentially enhanced patient outcomes. Our findings highlighted the substantial safety and efficiency benefits of near-infrared ray catheters in laparoscopic surgeries for kidney transplant patients. Further research with larger patient cohorts and varied surgical settings are essential to fully validate its clinical impact.