Combined Application of 3D Reconstruction and ICG Fluorescence Imaging in Pelvic Lymph Node Dissection for Bladder Cancer: A Retrospective Study

Objective: To evaluate the feasibility and safety of combining preoperative computed tomography (CT)-based three-dimensional (3D) reconstruction with indocyanine green (ICG) fluorescence imaging for guiding pelvic lymph node dissection (PLND) in bladder cancer. Methods: This retrospective study included 72 patients who underwent radical cystectomy with standard PLND between January 2023 and January 2026: 30 received preoperative CT-based 3D reconstruction plus ICG guidance (3D + ICG), and 42 received ICG guidance alone (ICG-only). Surgical and pathological outcomes were compared. PLND operative time and total lymph node yield were analyzed using multivariable linear and Poisson regression, respectively, with adjustment for calendar time and operating surgeon. A second model additionally adjusted for age, BMI, and pT stage. Recurrence outcomes were reported descriptively. Results: No significant differences were observed in baseline characteristics between the two groups. PLND operative time was shorter in the 3D + ICG group than in the ICG-only group (median [interquartile range (IQR)], 45 [42–48] vs 58 [52–64] min; p < 0.001), while total lymph node yield was higher (median [min–max], 17 [6–39] vs 11 [8–20]; p < 0.001). Lymph node yields were also higher in the internal iliac, external iliac, and obturator regions. After adjustment for calendar time and operating surgeon, these differences remained significant (operative time: adjusted β , −13.43 minutes; 95% confidence interval [CI]: −16.54 to −10.33; p < 0.001; total yield: adjusted IRR, 1.43; 95% CI: 1.24–1.65; p < 0.001). The effect estimates remained similar in the second model. Postoperative complication rates and Clavien–Dindo severity distributions did not differ significantly. During a median follow-up of 25 months (IQR: 14–31), recurrence was documented in 2 of 30 patients (6.7%) in the 3D + ICG group and 4 of 42 patients (9.5%) in the ICG-only group. Conclusion: The combined use of preoperative CT-based 3D reconstruction and intraoperative ICG fluorescence imaging was associated with shorter PLND operative time and a higher pelvic lymph node yield than ICG guidance alone.