THE ROLE OF ICG-FLUORESCENT IMAGING OF LYMPH NODES DURING ROBOT-ASSISTED RADICAL CYSTECTOMY IN PATIENTS WITH BLADDER CANCER

The aim of the study was to evaluate the technique of intraoperative fluorescent imaging of lymph nodes during robotassisted radical cystectomy in patients with bladder cancer. The study also aimed to analyze morphological characteristics of the removed lymph nodes and to compare the results of the histological examination with the data obtained during the operation using visualization.

Material and methods. The clinical prospective trial was performed at the Urology Department of the Bashkir State Medical University Clinic and included 28 patients who were diagnosed with bladder cancer based on the results of cystoscopy and transurethral resection of the tumor. All participants underwent robot-assisted radical cystectomy with extended pelvic lymphodissection and intracorporeal ileal urinary drainage using the Bricker technique under intraoperative fluorescent navigation.

During pelvic lymphadenectomy, intraoperative assessment of the extracted lymph nodes was performed using indocyanine green (ICG) fluorescence imaging to identify signaling lymph nodes. All the removed nodes were sent for histological examination, the results of which were analyzed taking into account the data obtained during surgery.

Results. The use of intraoperative fluorescence imaging using indocyanine green revealed signaling lymph nodes in 7 out of 9 patients (77.8%, p<0.05). The sensitivity of the method was 77.8% (p<0.05), and the specificity reached 87.5% (p<0.05), which indicates its high diagnostic accuracy.

Conclusion. The data obtained confirm the high reliability of the method of intraoperative imaging of lymph nodes using indocyanine green in patients suffering from muscle-invasive bladder cancer. The use of fluorescent navigation in oncosurgery expands the possibilities of improving the quality of perioperative management and helps to reduce the frequency of postoperative complications.

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