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Texas doctor uses fluorescent imaging in groundbreaking hysterectomy surgery

Dr. Richard Farnam of the Texas Urogynecology and Laser Surgery Center has launched a groundbreaking trial that has the potential to dramatically reduce the risk of ureter injury during surgery.    

Ureter injuries are the one of the most serious complications of gynecological and general surgeries.  The ureters are paired tubes within the body, which convey urine from each kidney down to the bladder. Due to their location there is a risk of injury during hysterectomy procedures as well as colorectal and vascular pelvic surgeries. At times the ureter is superficial and can be visualized with the naked eye and avoided, However in many cases the ureter is too deep within the tissue and cannot be seen without extensive dissection.

For the last decade, Farnam has initiated several studies and presented his research on the topic of incidental ureter injury prevention. On Wednesday, Feb. 15, 2017, Las Palmas Medical Center in El Paso, Texas became the first site to use a new fluorescent chemical (IS-001) in the world’s first in-woman pharmacokinetic trial performed by Farnam and his team.

Developed by engineers at Intuitive Surgical, the maker of the da Vinci and Xi surgical robot systems, IS-001 is an intravenously administered chemical, which can bind and illuminate proteins within the ureter.  Coupled with a special near-infrared laser in the robotic camera, this permits the surgeon to visualize the ureter even when deep within the tissue.

“With this chemical, not unlike Superman, our vision can now penetrate the tissue to visualize the ureter at any moment in the surgery and keep it out of harm’s way,” Farnam said.  

The implications of this innovation are far-reaching and historic.  The research conducted and analyzed from this Phase I trial is the first step in a process that may alter the standard of care in surgery. 

The risk of ureteral injury during a hysterectomy ranges from 0.2 to 1 percent, depending on the procedure.  Since there are 600,000 hysterectomies performed each year in the U.S., as many as 6,000 ureters are inadvertently injured annually during this common surgery. 

Ureter injury can also occur with other specialties and other surgeries such as colon resection (0.2 - 0.7%).  There have been several innovations directed at decreasing this complication - such as intraoperative ureteral stenting – however, data suggest that these measures only increase detection of injury but do not effectively prevent it.

 “If we can prevent even 50 percent of hysterectomy ureter injuries, 3,000 women per year will avoid this terrible complication, and many lives will be saved,” Farnam said. “And that only describes the impact of a single procedure in one specialty.  The potential ripple effect across specialties and surgeries is practically immeasurable. For the duration of my career this single innovation has the potential to positively affect tens of thousands of lives.”

Categories: Dr. Farnam in the NewsMinimally Invasive SurgeryHysterectomyRobotic Surgery Training and Education

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