Multidisciplinary, robotic-assisted approach to treatment of ovarian remnant syndrome involving retrograde instillation of indocyanine green fluorescence

Kristina Duan, Xiaoming Guan
In: Intelligent Surgery · 2022 · vol. 3 , pp. 5–8 · doi:10.1016/j.isurg.2022.05.001 · W4280633745
Case report OA: gold CC0 ⤵ 1 in-corpus citation
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A multidisciplinary team used robotic surgery and indocyanine green fluorescence retrograde instillation to successfully remove ovarian remnant tissue and endometriosis in a patient with recurrent pelvic pain.

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Abstract

Our objective here is to demonstrate multidisciplinary teamwork in complex gynecological cases. To this end, we report a complicated case of ovarian remnant tissue after oophorectomy in the context of advanced-stage endometriosis. A 35-year-old G1P1001 woman with previous hysterectomy and bilateral salpingo-oophorectomy (BSO) presented with recurrence of pelvic pain less than one year after Da Vinci single-incision laparoscopic surgery (SILS) for resection of stage IV endometriosis. A multidisciplinary team of surgeons including minimally invasive gynecology, gynecologic oncology, urology and colorectal surgery was assembled to work collaboratively on this case. The patient underwent robotic-assisted removal of ovarian remnant tissue and endometriosis with bowel resection and ureterolysis. A novel technique involving indocyanine green fluorescence imaging was applied retrograde through cystoscopy guidance into ureters bilaterally to facilitate challenging dissections. The postoperative course was notable for development of a pelvic abscess leading to pleural effusion. Although recovery was prolonged, the patient has been disease-free to date after discharge. The breadth of surgical expertise allowed for the thorough removal of remnants.

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endometriosis

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