Indocyanine green in intestinal endometriosis surgery: a multicenter evaluation of anastomotic safety

Objective: To evaluate whether the use of intraoperative indocyanine green (ICG) fluorescence impacts anastomotic safety and surgical outcomes in patients undergoing bowel endometriosis resection. Methods: Retrospective, multicenter observational study conducted in tertiary referral hospitals in the state of São Paulo, Brazil. A total of 1,090 patients who underwent surgery for bowel endometriosis between 2021 and 2025 were included, of whom 301 received ICG fluorescence assessment and 789 did not. Interventions: Surgical management of bowel endometriosis using shaving, discoid nodulectomy, or segmental resection, performed via laparoscopy or robotic surgery. Intraoperative fluorescence was used as an adjunct for bowel perfusion assessment during surgery. Results: Clinical variables, surgical technique, specimen extraction route, complications (classified by Clavien-Dindo), and length of hospital stay were analyzed. Patients in the ICG group underwent more complex procedures, with higher rates of segmental resection (53.2% vs. 17.3%; p < 0.001) and natural orifice specimen extraction (53.4% vs. 36.9%; p = 0.004). Overall postoperative morbidity, including anastomotic fistula (1.0% vs. 0.8%; p = 0.703) and reoperation (2.0% vs. 1.0%; p = 0.201), was similar between groups. After adjustment for surgical technique, ICG use was not independently associated with prolonged hospitalization. Conclusion: The application of indocyanine green fluorescence in bowel endometriosis surgery was safe and did not increase postoperative morbidity. Its use was concentrated in technically demanding cases, supporting its role as an adjunct for intraoperative perfusion assessment rather than a determinant of surgical outcomes. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

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Author information Authors and Affiliations Contributions R Barretto: Data collection and patient recruitmentMM Sonnenfeld: Writing of the manuscript, statistical analysis, and figure/table preparationRC Mariano da Silva: Data collection and chart reviewRP Gonçalves Filho: Data collection and critical review of the manuscriptGJ Saba: Data collection and clinical supervisionCRR Talaga: Data collection and literature reviewM Wajman: Data collection and database organizationT Moscovitz: Study design, methodological supervision, and text revisionCA Ortiz: Data collection and manuscript editingFB Manchini: Data collection and image reviewAG Manchini: Data collection and discussion inputN Rostey: Data collection and clinical case analysisB Mirandola Bulisani: Data collection and formatting supportLGL Gomes: Data collection and text formattingMR Rodrigues: Data collectionM Ströher: Data collection and patient follow-upLCB do Carmo: Data collection and support in institutional logisticsM Tcherniakovsky: Scientific supervision, study design, and critical manuscript review. Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 Supplementary Material 2 Supplementary Material 3 Supplementary Material 4 Supplementary Material 5 Supplementary Material 6 Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Barretto, R., Sonnenfeld, M.M., da Silva, R.C.M. et al. Indocyanine green in intestinal endometriosis surgery: a multicenter evaluation of anastomotic safety. J Robotic Surg 20, 253 (2026). https://doi.org/10.1007/s11701-025-03136-0 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-025-03136-0