ArticleFrontiers in oncology2026
Cystoscopic submucosal indocyanine green marking in robot-assisted radical nephroureterectomy: a multicenter cohort study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Distal ureter and bladder cuff dissection can be difficult during robot-assisted radical nephroureterectomy (RA-RNU) for upper tract urothelial carcinoma (UTUC), particularly in the deep pelvis where tactile feedback is limited. We evaluated cystoscopic submucosal indocyanine green (ICG) marking around the ureteral orifice as a navigation aid for this step. Methods: Adults who underwent RA-RNU with formal bladder cuff excision for clinically localized UTUC (≤T3, M0) at three centers between January 2019 and November 2024 were retrospectively analyzed. Outcomes were compared between submucosal ICG-guided and conventional non-ICG procedures. The primary endpoint was video-derived distal ureter and bladder cuff identification time; postoperative care-process measures were descriptive, and other perioperative and oncological outcomes were exploratory. Results: The analysis included 82 patients (43 ICG, 39 non-ICG). The ICG group was older, and the largest baseline imbalances by SMD involved age and pathological T stage. Median identification time was 9.0 min with ICG and 19.3 min without ICG (p < 0.001). In the primary parsimonious model, the geometric mean ratio was 0.49 (HC3 95% CI 0.45-0.53; p < 0.001). No statistically significant between-group difference was observed in Clavien-Dindo grade. During exploratory follow-up, intravesical recurrence occurred in 1/43 versus 2/39 patients and extravesical recurrence in 3/43 versus 8/39; event counts were insufficient for comparative inference. Conclusions: Submucosal ICG marking around the ureteral orifice was associated with faster distal ureter and bladder cuff identification during RA-RNU. Prospective studies are needed to confirm reproducibility and evaluate injection-specific safety and longer-term oncological outcomes.
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