Rectosigmoid Endometriosis Vascular Patterns at Intraoperative Indocyanine Green Angiography and their Correlation with Clinicopathological Data

Author:

Raimondo Diego1ORCID,Mastronardi Manuela1ORCID,Mabrouk Mohamed123,Cafagna Gabriella1,Salucci Paolo1,Arena Alessandro1,Iodice Raffaella1,Borghese Giulia1,Casadio Paolo1,Del Forno Simona1,Giaquinto Ilaria1,Caprara Giacomo4,Seracchioli Renato1

Affiliation:

1. Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Sant’Orsola Hospital, University of Bologna, Italy

2. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cambridge, UK

3. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Egypt

4. Histopathological and Molecular Diagnostic Unit of Solid Organ and Transplant, Sant’Orsola Hospital, University of Bologna, Italy

Abstract

Introduction. The objective of the study was to evaluate the presence of different rectosigmoid endometriosis (RSE) vascular patterns using intraoperative indocyanine green (ICG) angiography and their correlation with clinicopathological data. Material and Methods. A prospective pilot study on 30 consecutive symptomatic women affected by RSE and scheduled for minimally invasive surgery between May 2018 and January 2019. ICG was used for the intraoperative evaluation of RSE vascularization. Perfusion grade was classified as follows: 0-1 = no or low fluorescence (hypovascular pattern); 2 = regular fluorescence, similar to healthy surrounding rectosigmoid tract (isovascular pattern); and 3-4 = diffuse or abundant fluorescence (hypervascular pattern). Results. Thirty women were intravenously injected with ICG after nodule exposure. No adverse effects related to ICG use were noted. After a 5- to 50-s latency from ICG injection, the real-time direct visualization of RSE perfusion showed diffuse or abundant fluorescence in 12/30 (40%) women, while in the remaining 18/30 (60%), fluorescence was poor or absent. No statistical differences were observed between the 2 groups regarding preoperative, intraoperative, and histological variables analyzed, except for a maximum diameter of bowel lesions and microvessel density (MVD). Hypovascular nodules had a larger maximum diameter (39.5 ± 15.6 mm vs 30.3 ± 11.4 mm, P < .05) and lower MVD (154.6+/43.6 vs 281.1+/−77.4, P < .05) than hypervascular ones. Conclusions. ICG angiography is a feasible and safe technique to intraoperatively assess RSE vascularization. The majority (60%) of endometriotic nodule presented a hypovascular pattern. The hypovascular pattern seems to be associated with a larger nodule size and lower MVD.

Publisher

SAGE Publications

Subject

Surgery

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1. “The Green Peace” How ICG can prevent complications in endometriosis surgery?;Best Practice & Research Clinical Obstetrics & Gynaecology;2024-09

2. Research progress of indocyanine green fluorescence technology in gynecological applications;International Journal of Gynecology & Obstetrics;2023-11-13

3. Indocyanine Green Fluorescence-Guided Laparoscopic Ureterolysis for Complex Gynecological Surgeries;Clinical and Experimental Obstetrics & Gynecology;2023-05-30

4. Vascularisation in Deep Endometriosis: A Systematic Review with Narrative Outcomes;Cells;2023-05-05

5. Use of Fluorescence Guidance in Gynecology;The SAGES Manual of Fluorescence-Guided Surgery;2023

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