Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

Luigi Carlo Turco, Virginia Vargiu, Stefano Cianci, Valerio Gallotta, Anna Fagotti, Giuseppe Vizzielli, Maria Gabriella Ferrandina, Camilla Nero, Filippo Maria Capomacchia, Giovanni Scambia, Francesco Cosentino
2022 · doi:10.5281/zenodo.7313242 · W4308760224
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Near-infrared indocyanine green technology aids surgeons in identifying and confirming deep infiltrating endometriosis lesions during surgery, improving radicality.

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This video-article demonstrates the application of laparoscopic near-infrared technology with indocyanine green to assist in the surgical treatment of deep infiltrating endometriosis. The authors describe a case involving a 43-year-old woman where the technique was used alongside standard white light vision to inspect the abdomen and pelvis. The results indicated that near-infrared imaging provided intraoperative confirmation of suspected lesions, revealed hidden endometriosis localizations not apparent under white light, and facilitated the distinction between diseased tissue and healthy adjacent structures. This paper is centrally about endometriosis — specifically the use of near-infrared fluorescence imaging to improve the identification and radicality of surgical excision for deep infiltrating disease.

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Abstract

(1) Background: The surgical treatment (ST) of deep infiltrating endometriosis (DIE) presents technical difficulties and pitfalls. Surgeon’s experience and new technologies reduce the difficulty of identifying endometriosis lesions especially if small or hidden. Recently, the near-infrared technology with indocyanine green (NIR-ICG) associated with the standard vision in white light (WL) resulted useful in order to improve ST of DIE. The aim of this video-article is to show the utility of NIR-ICG during surgery for DIE. (2) Methods: During surgery the whole abdomen and pelvis are upfront visually inspected using normal WL vision than after intravenous ICG injection in NIR mode. All suspected areas for endometriosis in WL and fluorescent in NIR-ICG are removed and analyzed at pathology. (3) Results: This is the case of a fertility-desiring 43 years old woman affected by DIE and planned for ST. NIR-ICG enabled the Surgeon to have an intraoperative confirmation of endometriosis lesions already visualized in WL, permitted moreover to better identify other endometriosis localizations not clearly pathologic in the WL vision and also enabled to more easily distinguish endometriosis localizations from adjacent healthy-tissues. (4) Conclusion: NIR-ICG can support the Surgeon with an intra-operative confirmation of already identified suspected lesions and it facilitates to identify unnoticed or hidden lesions achieving greater radicality in ST for DIE.
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Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery Authors/Creators - 1. Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Roma, Italy - 2. Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood "G. Barresi", University of Messina, 98121 Messina, Italy - 3. Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy - 4. Gynecologic Oncology, Gemelli Molise, Campobasso, Italy Description (1) Background: The surgical treatment (ST) of deep infiltrating endometriosis (DIE) presents technical difficulties and pitfalls. Surgeon’s experience and new technologies reduce the difficulty of identifying endometriosis lesions especially if small or hidden. Recently, the near-infrared technology with indocyanine green (NIR-ICG) associated with the standard vision in white light (WL) resulted useful in order to improve ST of DIE. The aim of this video-article is to show the utility of NIR-ICG during surgery for DIE. (2) Methods: During surgery the whole abdomen and pelvis are upfront visually inspected using normal WL vision than after intravenous ICG injection in NIR mode. All suspected areas for endometriosis in WL and fluorescent in NIR-ICG are removed and analyzed at pathology. (3) Results: This is the case of a fertility-desiring 43 years old woman affected by DIE and planned for ST. NIR-ICG enabled the Surgeon to have an intraoperative confirmation of endometriosis lesions already visualized in WL, permitted moreover to better identify other endometriosis localizations not clearly pathologic in the WL vision and also enabled to more easily distinguish endometriosis localizations from adjacent healthy-tissues. (4) Conclusion: NIR-ICG can support the Surgeon with an intra-operative confirmation of already identified suspected lesions and it facilitates to identify unnoticed or hidden lesions achieving greater radicality in ST for DIE. Files Video.mp4 Files (495.7 MB) | Name | Size | Download all | |---|---|---| | md5:5fd63762a59dce85b19ee6545f07c50b | 495.7 MB | Preview Download |

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