THE TYPICAL DOSE OF ICG IN CYSTOSCOPY
| Discussion in 'All Categories' started by DR IMEN BEN SALAH - Oct 23rd, 2024 10:20 am. | |
DR IMEN BEN SALAH
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GOOD EVENING SIR I WANT TO KNOW THE DILUTION OF ICG FOR URETER VISUALIZATION BY CYSTOSCOPY THANK YOU |
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re: THE TYPICAL DOSE OF ICG IN CYSTOSCOPY
by Dr R K Mishra -
Dec 29th, 2024
12:41 pm
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Dr R K Mishra
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To introduce Indocyanine Green (ICG) into the ureter during Total Laparoscopic Hysterectomy (TLH) for direct visualization of ureteral anatomy, the dye is administered through the ureteral orifices using a cystoscope. Here’s the detailed protocol: Steps to Introduce ICG into the Ureter 1. Preparation: • Obtain a sterile ICG solution: • Reconstitute a 25 mg vial of ICG in 10 mL of sterile water or saline to prepare a 2.5 mg/mL stock solution. • Dilute this stock further to achieve a concentration of 1.25 mg/mL for ureteral instillation. 2. Cystoscopic Placement of Ureteral Catheters: • Perform cystoscopy to locate the ureteral orifices. • Introduce 5-Fr open-ended ureteral catheters into each ureteral orifice. 3. Instillation of ICG: • Using a syringe, inject 2–5 mL of the prepared 1.25 mg/mL ICG solution through the catheter into each ureter. 4. Visualization: • Use a near-infrared (NIR) fluorescence imaging system during laparoscopy. • The ureters will fluoresce under NIR light, aiding their identification and avoiding injury during dissection. Dose and Timing • Total Dose per Ureter: 2–5 mg of ICG (via 2–5 mL of the 1.25 mg/mL solution). • Timing: Instill the ICG immediately before or during dissection for real-time visualization. Key Considerations • Fluorescence System: • Ensure the laparoscope is equipped with a compatible NIR fluorescence imaging system to visualize the ureters effectively. • Renal Function: • Confirm normal renal function before using ICG, as impaired renal clearance may reduce fluorescence and increase risk. • Allergy Testing: • Rule out ICG allergy, particularly in patients with a history of iodine sensitivity. Clinical Utility • Direct ICG instillation into the ureter allows for precise identification of ureteral anatomy, significantly reducing the risk of injury during TLH, especially in cases involving dense adhesions, endometriosis, or distorted anatomy. Let me know if you’d like further clarification! |
