Fluorescence-guided nerve-sparing surgery for deep endometriosis using indocyanine green

Area of Science:

• Minimally Invasive Gynecological Surgery
• Surgical Navigation Technologies
• Endometriosis Research

Background:

• Nerve-sparing surgery for deep endometriosis (DE) improves outcomes but requires high surgical skill.
• Severe adhesions and fibrosis in DE can complicate lesion removal and nerve preservation.
• Indocyanine green (ICG) near-infrared (NIR) imaging is being explored to aid intraoperative identification in DE surgery.

Purpose of the Study:

• To demonstrate the step-by-step technique of single-port robotic nerve-sparing DE surgery.
• To illustrate the use of ICG navigation in this advanced surgical procedure.
• To provide educational insights into safer DE surgical techniques.

Main Methods:

• A 48-year-old female patient with chronic pelvic pain, adenomyosis, and DE was included.
• Intraoperative near-infrared fluorescence imaging was performed using ICG (0.25 mg/kg IV).
• The da Vinci Single-Port robotic system was utilized for the nerve-sparing DE surgery.

Main Results:

• ICG fluorescence enhanced visualization of pelvic autonomic nerves and DE lesions.
• The technique potentially aids in identifying DE, assessing organ injury, and evaluating tissue perfusion.
• Improved intraoperative decision-making is suggested with ICG-enhanced visualization.

Conclusions:

• ICG with NIR imaging may assist surgeons in nerve-sparing DE procedures.
• ICG can potentially highlight nerves, identify lesions, and assess tissue status.
• Further research is necessary to confirm the role of ICG in DE surgery.