Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis-A Feasibility Study

Diego Raimondo, Manuela Maletta, Maletta M, Borghese G, Giulia Borghese, Manuela Mastronardi, Alessandro Arena, Arena A, Simona Del Forno, Paolo Salucci, Salucci P, Ilaria Giaquinto, Giaquinto I, Paolo Casadio, Renato Seracchioli
Journal of Minimally Invasive Gynecology · 2021 · vol. 28(6) , pp. 1225–1230 · doi:10.1016/j.jmig.2020.12.017 · PMID:33352315 · W3117452967
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This feasibility study evaluated the use of indocyanine green fluorescence angiography to assess perfusion in patients undergoing full-thickness bowel resection for rectosigmoid endometriosis.

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Abstract

STUDY OBJECTIVE: To evaluate feasibility of near-infrared (NIR)-indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). DESIGN: This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020. SETTING: Tertiary university hospital. PATIENTS: Thirty-two women with RSE meeting eligibility criteria were included for study analysis. INTERVENTIONS: NIR-ICG evaluation of anastomotic line vascularization after RSE removal. MEASUREMENTS AND MAIN RESULTS: Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3-5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation. CONCLUSION: NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Indocyanine Green Indocyanine Green Colon Colon Feasibility Studies Feasibility Studies Female Female Fluorescein Angiography Fluorescein Angiography Humans Humans Prospective Studies Prospective Studies

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