Seracchioli R, et al. - Researchers presented the first report delineating the use of endovenous indocyanine green (ICG) during a bowel resection for deep endometriosis. They described its utility in allowing real-time visualization of bowel perfusion and selecting the transecting line in women with recto-sigmoid endometriosis who may be candidates for segmental resection. ICG fluorescence imaging may help in determining the adequate blood supply to the anastomosis. For objective vascular assessment, endovenous ICG is recognized as a simple and rapid to use tool with no related complications.

Methods

• Using descriptive text and educational video, researchers provided step-by-step explanation of this method.
• They performed this study at a tertiary level referral academic center.
• Referral to this center was made of a nulliparous 36-year-old woman affected by a large rectal endometriotic nodule for severe dysmenorrhea, dyspareunia, hematochezia, and dyschezia, despite progestinic therapy.
• For intraoperative fluorescence imaging, an intravenous injection of 1.5 mL solution containing 3.75 mg dose of ICG was administered.
• Blood perfusion of bowel and rectal endometriosis nodule was evaluated.
• Neoanastomosis vascularization after bowel resection was assessed.

Results

• Using the daVinciXi surgical platform (Intuitive Surgical, Sunnyvale, CA), researchers performed the procedure of endometriosis removal.
• The endometriosis nodule on the anterior surface of the rectum was identified after ovarian endometriosis removal and adhesiolysis.
• Dissection of pararectal, rectovaginal, and retrorectal spaces was done with a nerve-sparing technique.
• Through a peripheral line, they administered indocyanine green.
• After latency of a few seconds, a near-infrared camera head enabled vision of the colorant.
• The ischemic area was identified around the rectal nodule and perfusion areas was identified upstream and downstream from the lesion.
• Taking account of this objective evaluation, the transecting line for rectal resection was selected, beyond the limits of macroscopic disease.
• The rectal vascularization with ICG was checked after direct mechanical anastomosis.