Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy (all authors).
Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy (all authors).
J Minim Invasive Gynecol. 2021 Jul;28(7):1275-1276. doi: 10.1016/j.jmig.2020.09.010. Epub 2020 Sep 20.
To show feasibility of using indocyanine green (ICG) in endometriosis surgery, especially bowel endometriosis shaving, and to discuss its potential benefits.
Stepwise demonstration of this technique with narrated video footage.
Endometriosis is a common benign chronic disorder, characterized by the presence of endometrial tissue outside the uterus. Deep infiltrating endometriosis (DIE) represents the most aggressive presentation. Robot-assisted laparoscopy represents an important innovation and has opened new perspectives for the treatment of endometriosis, offering numerous advantages especially in the most complex procedures, particularly when extragenital endometriosis diffusely involves pelvic structures including the bowel and the urinary tract [1]. Endometriosis affects the bowel in 30% of DIE cases, and it is usually associated with ovarian and ureteral involvement; therefore, a multidisciplinary team with both general and gynecologic surgeons is required. The goal of endometriosis surgery in these cases is to obtain long-term outcomes without compromising intestinal function. One possible treatment is laparoscopic shave excision, which consists of dissection, keeping it as superficial as possible to avoid compromising bowel integrity [2]. Recent studies have shown that ICG can be useful to evaluate the size and depth of penetration of lesions during endometriosis surgery to understand shaving excision and to prevent a major iatrogenic intestinal complication [3-7].
Total robot-assisted laparoscopic approach to a DIE case with adnexal, uterine, and intestinal endometriosis, with the presence of a nodular rectal lesion. The excision consisted of several key strategies to minimize iatrogenic rectal injury: CONCLUSION: The approach to DIE, particularly rectal endometriotic lesions, could be more accurate with ICG evaluation of vascular pertinence, in attempt to evaluate shaving feasibility of lesions in endometriosis laparoscopic robotic surgery.
展示吲哚菁绿（ICG）在子宫内膜异位症手术中的应用可行性，特别是肠子宫内膜异位症刮除术，并探讨其潜在益处。
通过解说视频逐步展示该技术。
子宫内膜异位症是一种常见的良性慢性疾病，其特征是子宫内膜组织出现在子宫外。深部浸润性子宫内膜异位症（DIE）代表最具侵袭性的表现。机器人辅助腹腔镜代表了一项重要的创新，为子宫内膜异位症的治疗开辟了新的视角，提供了许多优势，特别是在最复杂的手术中，特别是当外生殖器子宫内膜异位症广泛累及包括肠道和泌尿道在内的骨盆结构时 [1]。在 30%的 DIE 病例中，肠道会受到子宫内膜异位症的影响，并且通常与卵巢和输尿管受累有关；因此，需要一个由普通外科医生和妇科医生组成的多学科团队。在这些情况下，子宫内膜异位症手术的目标是在不损害肠道功能的情况下获得长期效果。一种可能的治疗方法是腹腔镜刮除术，它包括解剖，尽可能保持浅层以避免损害肠道完整性 [2]。最近的研究表明，ICG 可用于评估子宫内膜异位症手术中病变的大小和穿透深度，以了解刮除术并防止重大医源性肠道并发症 [3-7]。
全机器人辅助腹腔镜方法治疗 DIE 病例，伴有附件、子宫和肠道子宫内膜异位症，以及直肠结节性病变。切除包括几个关键策略，以最大程度地减少医源性直肠损伤：
通过 ICG 评估血管相关性，对 DIE，特别是直肠子宫内膜异位病变的处理可以更加准确，尝试评估腹腔镜机器人手术中子宫内膜异位症病变的刮除可行性。
