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

Luigi Carlo Turco
2022 · doi:10.5281/zenodo.7332180 · W4320026823
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Laparoscopic near-infrared technology with indocyanine green assists surgeons in confirming and identifying deep infiltrating endometriosis lesions during surgery, facilitating better distinction from healthy tissue compared to white light vision alone.

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This video-article demonstrates the application of laparoscopic near-infrared technology with indocyanine green to enhance the surgical treatment of deep infiltrating endometriosis. The authors present a case study of a 43-year-old woman where the technique allowed for intraoperative confirmation of lesions visible in white light and facilitated the identification of additional, less obvious disease sites. By distinguishing endometriotic tissue from adjacent healthy structures more effectively than standard vision alone, the method supported greater radicality in lesion removal. This paper is centrally about endometriosis — specifically the use of fluorescence imaging to improve the precision 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 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.

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