Indocyanine Green–Assisted Retrograde Ureterolysis in Robotic Transvaginal NOTES for the Management of Stage IV Endometriosis with Obliterated Cul-de-sac

Guan, Xiaoming; Guan, Zhenkun; Sunkara, Sowmya; Thigpen, Brooke

doi:10.1016/j.jmig.2023.02.005

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…The utilisation of ICG fluorescence greatly aided in the identification and safe dissection of the ureters, effectively preventing potential injuries to the urinary tract. 13 In our study of 53 cases, there were no urinary tract injuries during the RvNOTES procedures. Figure 1 illustrates stent placement with retrograde ICG injection.…”

Section: Discussionmentioning

confidence: 53%

“…This procedure, as detailed in the case report, was performed on a patient with deep infiltrating endometriosis, which also involved an obliterated cul‐de‐sac. The utilisation of ICG fluorescence greatly aided in the identification and safe dissection of the ureters, effectively preventing potential injuries to the urinary tract 13 …”

Section: Discussionmentioning

confidence: 99%

“…Retrograde ureterolysis was typically performed for all cases starting at the level of the uterine artery, even in instances of stage 4 endometriosis with an obliterated cul-de-sac. 13 Once the hysterectomy was complete, surgical resection of endometriosis involving the use of bipolar forceps, monopolar scissors, and blunt dissection subsequently followed until all identifiable disease was removed. Once haemostasis was ensured for all surgical pedicles, the da Vinci Xi robot was undocked and vaginal cuff closure was completed using a barbed suture.…”

Section: Surgical Techniquementioning

confidence: 99%

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Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection

Delgadillo Chabolla,

Alpuing Radilla,

Koythong

et al. 2024

Robotics Computer Surgery

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BackgroundTo assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES).MethodsWe conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection.ResultsThe study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98 ± 6.65 years. Operative time averaged 181.32 ± 53.94 min, with estimated blood loss at 45.57 ± 33.62 mL. Postoperative stay averaged 0.23 ± 0.47 days. No ICG‐related complications occurred.ConclusionNo complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

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Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection

Delgadillo Chabolla,

Alpuing Radilla,

Koythong

et al. 2024

Robotics Computer Surgery

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“…This technique enables rapid and accurate identification of the ureter and precise localization of ureteral stenosis 19 . Building on this technology, Guan et al recently published a case report where they successfully performed surgery for endometriosis with the assistance of this technique, avoiding inadvertent ureteral damage during surgery 20 . Furthermore, Nitta et al used the IRIS U kit for indocyanine green injection into the urethra during low anterior resection of total mesorectal excision (TME) for rectal cancer, followed by visualization under NIR.…”

Section: Discussionmentioning

confidence: 99%

Real-time fluorescence-guided adhesiolysis with indocyanine green in intra-abdominal surgery (with video)

Chen,

Cai,

Cheng

et al. 2024

Sci Rep

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Intra-abdominal adhesions have consistently posed a challenge for surgeons during procedures. This study aims to investigate the feasibility of utilizing indocyanine green (ICG) in conjunction with near-infrared imaging for the detection of intra-abdominal adhesions. In vitro, we analyzed factors affecting ICG fluorescence. We divided SD rats into groups to study ICG excretion in different digestive tract regions. Additionally, we reviewed surgical videos from previous cholecystectomy cases, categorizing them by ICG injection timing and assessing fluorescence imaging in various digestive tract regions. Finally, we preoperatively injected ICG into two cholecystectomized patients with abdominal adhesions, guiding intraoperative adhesiolysis with near-infrared fluorescence imaging. In vitro, we observed a significant influence of protein and ICG concentrations on ICG fluorescence intensity. Our rat experiments unveiled a strong and highly significant correlation (Kendall’s tau-b = 1, P < 0.001) between the timing of ICG injection and the farthest point of intestinal fluorescence. A retrospective case analysis further validated this finding (Kendall’s tau-b = 0.967, P < 0.001). Under the guidance of fluorescence navigation, two cholecystectomized patients with intra-abdominal adhesions successfully underwent adhesiolysis, and no postoperative complications occurred. The intraoperative combination of ICG with near-infrared fluorescence imaging effectively enhances the visibility of the liver, bile ducts, and various segments of the gastrointestinal tract while providing real-time navigation. This real-time fluorescence guidance has the potential to aid surgeons in the dissection of intra-abdominal adhesions.

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“…Another study described a robot-assisted transvaginal NOTES hysterectomy with resection of deeply infiltrating endometriosis. In their study, preoperatively 5 cc of ICG was injected after insertion of the ureteral stents [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Fluorescence guidance during robotic resection of bladder wall endometriosis: case report and technique

Bruneel,

Ghysel,

Van Holsbeke

et al. 2023

Journal of Surgical Case Reports

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The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5–2 cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.

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Indocyanine Green–Assisted Retrograde Ureterolysis in Robotic Transvaginal NOTES for the Management of Stage IV Endometriosis with Obliterated Cul-de-sac

Cited by 8 publications

References 6 publications

Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection

Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection

Real-time fluorescence-guided adhesiolysis with indocyanine green in intra-abdominal surgery (with video)

Fluorescence guidance during robotic resection of bladder wall endometriosis: case report and technique

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