Electrothermal ureteral injuries are a frequent complication during pelvic surgery. The ureters, which are delicate tubes carrying urine from the kidneys to the bladder, are especially at risk due to their proximity to other anatomical structures. Unfortunately, existing detection methods often fail to quickly identify subtle thermal injuries, which may take days or weeks to become apparent. Now, a new study has demonstrated that optical coherence tomography (OCT) endoscopy, a minimally invasive imaging technique, could transform how ureteral injuries are detected.

This research, led by an interdisciplinary team at the University of Arizona (Tucson, AZ, USA), involved applying electrothermal energy externally to explanted pig ureters to mimic varying degrees of injury severity. Right after this application, the researchers performed OCT endoscopy on these tissues and compared the images to histology, which is the gold standard for interpreting such injuries. The results were striking. The size of the lesions observed in OCT images correlated with the power of treatment applied, offering a quantitative measure of the injury severity. Additionally, qualitative markers of injury were visible in almost all instances, with only one low-power lesion being the exception. Trained physicians were able to identify these features with an average sensitivity of 82% and specificity of 96% in lesion detection.

Although the study was limited by its small sample size and its ex vivo setting, the findings indicate that OCT endoscopy has substantial potential. This technique can provide timely and precise detection of electrothermal ureteral injuries, potentially enhancing patient outcomes and reducing postoperative complications. This innovative approach could soon provide surgeons with a valuable tool, boosting safety and accuracy during pelvic surgeries.

“This study provides an important step towards protecting patients from ureteral injuries during pelvic surgery,” said Darren Roblyer of Boston University. “OCT is label-free, safe for the patient, and can be integrated into a remarkably small-diameter endoscope, provide a potentially excellent means for detecting and ultimately preventing these unfortunate injuries.” 

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