{"paper_id":"29c0ef93-5aa7-49c6-bfa7-5ca4c8d08498","body_text":"Abstract\nWe present our preliminary experience comparing robotic near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) to 2D laparoscopic white light (WL) and 3D robotic WL illumination, in their ability to visually detect endometriosis lesions during a robotic endometriosis resection procedure in a single center. A total of twenty women were screened and seven of them with symptomatic endometriosis were included in this prospective case series. The mean patient age was 33 years with the mean body mass index being 28.6 kg/m2. The NIRF-ICG imaging technique enabled visualization of a statistically significant higher number of lesions compared to that of robotic and laparoscopic WL (13.4 vs 7.4 vs 4.7, p = 0.012). In addition, we explored the extent of quality of life (QoL) measures of these women affected by endometriosis using the validated QoL RAND Short Form Health Survey questionnaire and Numeric Pain Rating Scale. The largest reduction of quality of life was measured for the domains of social functioning (3.28 SD, 95% CI 45.7–61.5, p = 0.0001), physical limitations (3.04 SD, 95% CI 15.1–44.3, p = 0.0002), and physical functioning (3.02 SD, 95% CI 48.7–64.1, p = 0.0002), respectively. There was a significant reduction in the postoperative mean pain score as indicated by the pain rating of 0.57 ± 0.78 (p = 0.0005). We also performed a literature search to review other cases that describe the potential benefits of robotic NIRF-ICG imaging in the visual detection of peritoneal and deep endometriosis. Our study results demonstrate that the ICG fluorescence system may potentially be useful for more complete intraoperative endometriosis lesion detection and excision. Large multicenter trials with larger sample sizes and across surgeons of differing experience levels are needed to investigate the clinical utility, reproducibility and long-term outcomes of the use of this technology for patients with debilitating endometriosis.\nSimilar content being viewed by others\nReferences\nKennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R et al (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704\nKvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L et al (2015) Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update 21:500–516\nKlein S, D'Hooghe T, Meuleman C, Dirksen C, Dunselman G, Simoens S (2014) What is the societal burden of endometriosis-associated symptoms? A prospective Belgian study. Reprod Biomed Online 28:116–124\nAbbott JA, Hawe J, Hunter D, Holmes M, Finn P, Garry R (2004) Laparoscopic excision of endometriosis: a randomized, placebo controlled trial. Fertil Steril 82:878–884. https://doi.org/10.1016/j.fertnstert.2004.03.046\nThe Practice Committee of the American Society for Reproductive Medicine (2014) Treatment of pelvic pain associated with endometriosis. Fertil Steril 10:927–935. https://doi.org/10.1016/j.fertnstert.2014.02.012\nNisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML (2016) Imaging modalities for the non-invasive diagnosis of endometriosis Cochrane Database Syst Rev 2:CD009591.https://doi.org/10.1002/14651858.CD009591.pub2\nJansen RP, Russell P (1986) Nonpigmented endometriosis: clinical, laparoscopic, and pathologic definition. Am J Obstet Gynecol 155:1154–1159\nWalter AJ, et al. (2001) Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol 1841407-11 (discussion 1411-3)\nMarchino GL et al (2005) Diagnosis of pelvic endometriosis with use of macroscopic versus histologic findings. Fertil Steril 84:12–15\nTaylor E, Williams C (2010) Surgical treatment of endometriosis: location and patterns of disease at reoperation. Fertil Steril 93:57–61\nCheong Y, Tay P, Luk F, Gan HC, Li TC, Cooke I (2008) Laparoscopic surgery for endometriosis: how often do we need to re-operate? J Obstet Gynaecol 28:82–85\nHandgraaf HJ, Verbeek FP, Tummers QR, Boogerd LS, van de Velde CJ, Vahrmeijer AL Gaarenstroom KN (2014) Real-time near-infrared fluorescence guided surgery in gynecologic oncology: a review of the current state of the art. Gynecol Oncol 135(3):606-613. https://doi.org/10.1016/j.ygyno.2014.08.005\nDulemba JF, Pelzel C, Hubert HB (2013) Retrospective analysis of robot-assisted versus standard laparoscopy in the treatment of pelvic pain indicative of endometriosis. J Robotic Surg 7:163–169. https://doi.org/10.1007/s11701-012-0361-4\nNezhat C, Lewis M, Kotikela S et al (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758–2760. https://doi.org/10.1016/j.fertnstert.2010.04.031\nHays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-Item Health Survey 10. Health Econ 2:217–227\nWare JE, Kosinski M, Keller SD (1994) SF-36 physical and mental health summary scales: a user's manual. The Health Institute, Boston\nObidoa CA, Reisine SL, Cheniack M (2010) How does the SF-36 perform in healthy populations? A structured review of longitudinal studies. J Soc Behav Health Sci. 4:30–48\nRodriguez CS (2001) Pain measurement in the elderly: a review. Pain Manag Nurs 2:38–46\nHawker GA (2011) Measures of adult pain. Arthritis Care Res 63:S240–S252\nCohen J (1998) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, New Jersey\nLaschke MW, Menger MD (2018) Basic mechanisms of vascularization in endometriosis and their clinical implications. Hum Reprod Update 24:207–224. https://doi.org/10.1093/humupd/dmy001\nPotente M, Gerhardt H, Carmeliet P (2011) Basic and therapeutic aspects of angiogenesis. Cell 146:873–887\nAsahara T, Kawamoto A (2004) Endothelial progenitor cells for postnatal vasculogenesis. Am J Physiol Cell Physiol 287:C572–C579\nLue JR, Pyrzak A, Allen J (2016) Improving accuracy of intraoperative diagnosis of endometriosis: role of firefly in minimal access robotic surgery. J Minim Access Surg 12:186–189. https://doi.org/10.4103/0972-9941.158969\nTang NZ, Goldman TL, Prabakar C (2015) Robotically-assisted laparoscopic resection of endometriosis using firefly technology. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2015.08.552\nLevey KA (2014) Use of fluorescence imaging technology to identify peritoneal endometriosis: a case report of new technology. Surg Laparosc Endosc Percutan Tech 24(2):e63–e65\nGuan X, Nguyen MT, Walsh TM, Kelly B (2016) Robotic single-site endometriosis resection using firefly technology. J Minim Invasive Gynecol 23(1):10–11. https://doi.org/10.1016/j.jmig.2015.08.001\nLövkvist L, Bostrom P, Edlund M, Olovsson M (2016) Age related differences in quality of life in Swedish women with endometriosis. J Womens Health 25:646–653\nMarki G, Bokor A, Rigo J, Rigo A (2017) Physical pain and emotion regulation as the main predictive factors of health related quality of life in women living with endometriosis. Hum Reprod 32(1432–1438):13\nJuan J, Estiarte R, Colome E, Artes M, Jimenez FJ, Alonso J (2003) Burden of illness of Crohn’s disease in Spain. Dig Liver Dis 35:853–861\nSimoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I et al (2012) The burden of Endometriosis: costs and quality of life of women with endometriosis and treated in referral centers. Hum Reprod 27:1292–1299\nAl-Taher M, Hsien S, Schols RM, Hanegem NV, Bouvy ND, Dunselman GAJ, Stassen LPS (2018) Intraoperative enhanced imaging for detection of endometriosis: a systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 224:108–116. https://doi.org/10.1016/j.ejogrb.2018.03.020\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nJayapriya Jayakumaran, Zoran Pavlovic, Daniele Fuhrich, Cynthia Buffington, and Aileen Caceres declare that they have no conflict of interest.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nJayakumaran, J., Pavlovic, Z., Fuhrich, D. et al. Robotic single-site endometriosis resection using near-infrared fluorescence imaging with indocyanine green: a prospective case series and review of literature. J Robotic Surg 14, 145–154 (2020). https://doi.org/10.1007/s11701-019-00951-0\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s11701-019-00951-0","source_license":"CC0","license_restricted":false}