Near-Infrared Imaging with Indocyanine Green for Detection of Endometriosis Lesions (Gre-Endo Trial): A Pilot Study

Cosentino, Francesco; Vizzielli, Giuseppe; Turco, Luigi Carlo; Fagotti, Anna; Cianci, Stefano; Vargiu, Virginia; Zannoni, Gian Franco; Ferrandina, Gabriella

doi:10.1016/j.jmig.2018.02.023

Cited by 47 publications

(67 citation statements)

References 14 publications

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“…There was even a decrease in positive predictive value for WL laparoscopy alone compared with the combination of WL laparoscopy plus NIR‐ICG imaging. In contrast to our findings, a previously published pilot study on 27 patients showed excellent results for NIR fluorescence imaging with ICG, with a sensitivity of 82%, a specificity of 97.9% and a positive predictive value of 97.8%, as well as of 13.8% of additionally identified endometriosis lesions due to ICG only …”

Section: Discussioncontrasting

confidence: 99%

“…It is obvious that it is necessary to wait for the extravasation of the ICG dye into the surrounding tissue because neovascularization in endometriosis—as in neoplastic lesions—leads to vessel leakage . This observation is in accordance with the findings of the abovementioned Gre‐Endo‐Trial, which reported an interval time from a minimum of 5 to a maximum of 30 minutes between ICG administration and the activation of the NIR‐ICG imaging . Previous studies showed that neoangiogenesis is typical for DIE, as these lesions have higher expressions of vascular endothelial growth factor A (VEGF‐A) and increased blood vessel density .…”

Section: Discussionsupporting

confidence: 81%

“…The subgroup analysis provides some explanations for the contradictory findings between our study and the Gre‐Endo‐Trial: in our cohort, the majority of the patients had previous abdominal surgery (62.5%), preoperative hormonal treatment (60.3%) and a rASRM stage III or IV (57.4%)—all diminishing the ICG detection rate. Furthermore, ICG exposure time was <10 minutes in 65.1% of our cohort.…”

Section: Discussionmentioning

confidence: 61%

“…Recently, near‐infrared (NIR) imaging using ICG has gained popularity in different surgical applications, including identification of colorectal liver metastases, assessment of skin flap perfusion, and sentinel lymph node mapping in gynecologic cancers . A pilot study has shown promising results in intraoperative detection and confirmation of endometriosis lesions in 27 patients . In addition, several encouraging case reports have been published about the detection of endometriosis and the resection of DIE nodules using near‐fluorescence imaging and ICG.…”

Section: Introductionmentioning

confidence: 99%

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Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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Introduction:Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. Material and methods:In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. Clinical trial registration: clinicaltrials.gov NCT03850158. Results:In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. Conclusions: The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal Preoperative symptoms, n (%) Pain 45 (71.4) Infertility 4 (6.3) Both 13 (20.6) Prior surgery for endometriosis, n (%) 34 (54.0) Previous abdominal surgery, n (%) 40 (63.5) Preoperative hormonal treatment, n (%) 38 (60.3) Abbreviations: n, number of patients; SD, standard deviation; rASRM, revised American Society for Reproductive Medicine.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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“…The most severe form of the disease is represented by deep infiltrating endometriosis, defined as endometriotic lesions infiltrating pelvic organ wall or retroperitoneal structures (4). Deep lesions are typically multifocal, involving most commonly uterosacral ligaments, upper third of posterior vaginal wall, bowel, bladder and ureters (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study)

Raimondo

Turco

Cosentino

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Recto-vaginal endometriosis surgical management needing partial colpectomy is a surgically challenging condition and has been associated with a notable risk of major postoperative complications. In the present study we sought to compare feasibility and safety of total laparoscopic (TL) and vaginal-assisted (VA) routes in women affected by symptomatic rectovaginal endometriosis with vaginal mucosa infiltration scheduled for minimally invasive surgery. Material and methods: Multi-centric, retrospective cohort study on medical records of consecutive reproductive age women submitted to complete macroscopic eradication of symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration between March 2013 and November 2017. The two groups were compared in terms of preoperative data and surgical outcomes. Results: 84 women were included in the study (TL=57 and VA=27). The two groups were comparable in terms of preoperative, surgical and postoperative data. The major postoperative complications rate was 5.3% (three out of 57) in TL group and 7.4% (two out of 27) in VA group, without a significant difference. In the TL group we reported one case of bowel anastomosis dehiscence and two cases of pelvic abscess; in the VA group, one case of small bowel perforation after extensive adhesiolysis treated with ileal resection and one case of rectal subocclusion after segmental resection and mechanical anastomosis were noticed. Conclusions: In women affected by recto-vaginal endometriosis with vaginal mucosal infiltration, perioperative outcomes seem not to be influenced by the surgical route adopted.

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Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study

Turco,

Raimondo,

Raffone

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo compare safety and effectiveness of two‐different directions of suturing the posterior vaginal breach (horizontal [Ho] vs vertical [Ve]) in women undergoing recto‐vaginal endometriosis (RVE) nodule resection.MethodsA multicenter, retrospective, observational, cohort study was performed including all women of reproductive age undergoing RVE nodule resection between March 2013 and December 2018 at our tertiary centers. Patients included in the present study were divided into two groups based on the direction in suturing the posterior vaginal fornix defect, for comparisons in terms of rate of postoperative complications, pain relief, pain and anatomical recurrence, and length of hospital stay. Univariate comparisons were performed adopting the t test or the Mann–Whitney test for continuous data and the chi‐square test or the Fisher exact test for categorical data, with a significant P value set to <0.05.ResultsA total of 101 women were included: 67 in the Ho‐group and 34 in the Ve‐group. The two groups did not significantly differ in length of hospital stay (6.7 ± 6.9 vs 6.6 ± 3.3 days; P = 0.95), overall postoperative complications (32.8% vs 14.7%; P = 0.05), pain recurrence (35.8% vs 26.5%; P = 0.34) and anatomical recurrence rate (19.4% vs 23.5%; P = 0.62). Conversely, grade III complications were significantly more common in the Ho‐group than in the Ve‐group (22.7% vs 20%, P = 0.009), while pain relief in terms of deep dyspareunia, dyschezia, dysuria and chronic pelvic pain was more consistent in the Ve‐group patients (P = 0.04, 0.04, 0.05, 0.004, respectively).ConclusionIn symptomatic women undergoing RVE nodule resection, Ho suturing of the vaginal breach appears more commonly associated with severe postoperative complications and a worse pain control.

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Near-Infrared Imaging with Indocyanine Green for Detection of Endometriosis Lesions (Gre-Endo Trial): A Pilot Study

Cited by 47 publications

References 14 publications

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study)

Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study

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