Improving accuracy of intraoperative diagnosis of endometriosis: Role of firefly in minimal access robotic surgery

Abstract

Endometriosis continues to be a major primary gynecologic etiology of chronic pelvic pain. The symptom profile, which includes cyclic pelvic pain, dysmenorrhea, and dyspareunia or dyschezia, is nonspecific and does not correlate with the extent or severity of disease. Trans-vaginal or trans-rectal ultrasound, as well as magnetic resonance imaging, can help visualize endometriomas and deeply infiltrating endometriosis. Additionally, there have been no serum marker tests available so far. However, even intraoperatively, the diagnosis may be missed, leading to under diagnosis and delayed or noninitiation of treatment. There are thought to be three distinct endometriotic lesions of the pelvis that are seen laparoscopically. The first is that which is visible on the pelvic peritoneal surface or the surface of the ovary, which is commonly termed peritoneal endometriosis. Second, endometriotic lesions that occur within the ovary and form cysts that are often lined with endometrioid mucosa are termed endometriomas. Lastly, rectovaginal endometriomas are endometriotic lesions that contain a mixture of adipose and fibrous tissue located between the rectum and vagina. All of these lesions can be singular or multiple and the pelvis may contain one or all three types of lesions. The shared histologic feature with all three lesions is the presence of endometrial epithelial cells or endometrial stroma. During a diagnostic procedure, the da-Vinci robot and its firefly mode allow for three dimensional visualization and seven degrees of instrument articulation for meticulous dissection of fibrotic areas of peritoneum that may contain deep infiltrating lesions of endometriosis. This case report describes a relatively new and innovative technique for effectively diagnosing and successfully treating endometriosis when other less invasive methods have failed.

Correlative factors associated with the recurrence of ovarian endometriosis: a retrospective study

“…Conservative surgery can not only remarkably control pain symptoms and improve reproductive prognosis but may also be superior to medical therapy by the removal of visible endometriosis lesions. However, some lesions, such as subperitoneal implants, microscopic foci or nonpigmented forms of endometriosis, may be difficult to visualize and detect during surgery [18]. These lesions may avoid surgical resection and remain in the pelvic cavity, thereby becoming the source of recurrence.…”

Key clinical applications for indocyanine green fluorescence imaging in minimally invasive colorectal surgery

“…Some of them will, undoubtedly, be transformed into the standard of care in the near future. [ 42 43 44 ]…”

The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR–ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature

“…Indocyanine green (ICG) is a fluorescent dye which binds plasma proteins in the vascular system [1][2][3]. Kodak laboratories invented ICG dye for near infra-red (NIR) photography in 1955 and it was later approved by the FDA for clinical use in 1959 [4].…”