Clinical Use of Indocyanine Green in Bowel Endometriosis Surgery

Vito Cela, Papini F, Francesca Papini, Vacca C, Chiara Vacca, Vergine F, Francesca Vergine, Elisabetta Micelli, Micelli E, Maria Elena Rosa Obino, Maria E R Obino, Obino MER, A Canu, Alessio Canu, Malacarne E, Elisa Malacarne
Journal of Minimally Invasive Gynecology · 2020 · vol. 28(7) , pp. 1275–1276 · doi:10.1016/j.jmig.2020.09.010 · PMID:32966892 · W3087045919
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This video demonstration illustrates the feasibility of using indocyanine green to evaluate vascular pertinence and shaving feasibility during robot-assisted laparoscopic surgery for deep infiltrating bowel endometriosis.

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Abstract

STUDY OBJECTIVE: To show feasibility of using indocyanine green (ICG) in endometriosis surgery, especially bowel endometriosis shaving, and to discuss its potential benefits. DESIGN: Stepwise demonstration of this technique with narrated video footage. SETTING: Endometriosis is a common benign chronic disorder, characterized by the presence of endometrial tissue outside the uterus. Deep infiltrating endometriosis (DIE) represents the most aggressive presentation. Robot-assisted laparoscopy represents an important innovation and has opened new perspectives for the treatment of endometriosis, offering numerous advantages especially in the most complex procedures, particularly when extragenital endometriosis diffusely involves pelvic structures including the bowel and the urinary tract [1]. Endometriosis affects the bowel in 30% of DIE cases, and it is usually associated with ovarian and ureteral involvement; therefore, a multidisciplinary team with both general and gynecologic surgeons is required. The goal of endometriosis surgery in these cases is to obtain long-term outcomes without compromising intestinal function. One possible treatment is laparoscopic shave excision, which consists of dissection, keeping it as superficial as possible to avoid compromising bowel integrity [2]. Recent studies have shown that ICG can be useful to evaluate the size and depth of penetration of lesions during endometriosis surgery to understand shaving excision and to prevent a major iatrogenic intestinal complication [3-7]. INTERVENTIONS: Total robot-assisted laparoscopic approach to a DIE case with adnexal, uterine, and intestinal endometriosis, with the presence of a nodular rectal lesion. The excision consisted of several key strategies to minimize iatrogenic rectal injury: CONCLUSION: The approach to DIE, particularly rectal endometriotic lesions, could be more accurate with ICG evaluation of vascular pertinence, in attempt to evaluate shaving feasibility of lesions in endometriosis laparoscopic robotic surgery.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Digestive System Surgical Procedures Digestive System Surgical Procedures Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Rectal Diseases Rectal Diseases Rectal Diseases Female Female Humans Humans Indocyanine Green Indocyanine Green Rectum Rectum Treatment Outcome

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References (7)

Cited by (9)

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