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Updated: Jun 25, 2026
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Ovarian vascularisation assessment using indocyanine green after laparoscopic treatment of ovarian cysts - A
Anne-Sophie Grémeau1, Alexandre Julien2, Nicolas Bourdel2
1Department of Gynaecological Surgery, 1 Lucie & Raymond Aubrac Street 63100 Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Department of Biology and Reproductive Medicine, Clermont-Ferrand University Hospital, 1 Lucie & Raymond Aubrac Street, 63100 Clermont-Ferrand, France.
Objective:
This study aimed to evaluate the feasibility of using indocyanine green (ICG) to assess vascularisation by visualizing ovarian fluorescence after laparoscopic cystectomy or plasmajet therapy. The secondary objective was to assess its potential as a surgical marker for predicting the risk of ovarian reserve impairment.
Settings:
The research design was a prospective feasibility study conducted in the gynecological surgery department at Clermont Ferrand University Hospital.
Participants:
A total of 45 participants aged 18 to 42 years who required laparoscopic surgical treatment for a benign ovarian cyst (<10 cm in diameter) were included in the study.
Intervention:
The participants underwent laparoscopic cystectomy or plasmajet therapy with intraoperative evaluation of ovarian vascularisation using ICG fluorescence. Ovarian reserve was assessed using AMH levels and AFC at baseline (M0) and at 6 and 12 months postoperatively (M6 and M12). Pregnancy outcomes were also recorded.
Results:
Fluorescence was observed in 100% of cases, with Likert scores ≥3 in 80% of the participants. No adverse effects related to ICG were identified. No correlation was found between ICG intensity and ovarian reserve measures. Postoperative follow-up demonstrated a decrease in AMH levels at M6, followed by a halt in this decline at M12 with a tendency toward amelioration halt at M12(2.42 [1.12; 2.71] at M0 then 1.23 [0.37; 2.23] ng/mL at M6; p < 0.001) then 1.46 [0.66; 2.67] ng/mL at M12; p < 0.342) and increased AFC (M0: 11 [8; 18] ; M + 6: 17 [9; 20]; p = 0.018 ; M + 12: 19 [12; 27]; p = 0.001). Among the 26 participants who desire pregnancy, 38.5% conceived spontaneously, and 16% were referred to Assisted Reproductive Technology (ART).
Conclusion:
The use of ICG fluorescence is a feasible approach to the intraoperative assessment of ovarian vascularisation. However, its utility in guiding clinical decisions remains to be demonstrated.