Tam Teresa, Mabini Christopher, Fernandez Carlos M, Levine Elliot M
Department of Obstetrics and Gynecology, Ascension Saint Francis Hospital, 55 Ridge Ave, Evanston, IL, 60202, USA.
Advocate Aurora Illinois Masonic Medical Center, 300 N. Halsted, Chicago, IL, 60657 , USA.
Arch Gynecol Obstet. 2025 Jun 24. doi: 10.1007/s00404-025-08071-x.
To present a case of a 43-year-old woman with a uterine isthmocele causing severe abnormal uterine bleeding (AUB) and chronic pelvic pain and to demonstrate the effectiveness of indocyanine green (ICG) fluorescence in minimally invasive surgical management.
A 43-year-old woman, gravida 7, para 2052, was referred for surgical management of a uterine isthmocele after experiencing persistent AUB and chronic pelvic pain despite multiple conservative treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapy. The patient expressed a desire to avoid hysterectomy.
Preoperative evaluation included a 2-dimensional transvaginal ultrasound (2D-TVUS) with saline infusion sonohysterogram (SIS), which revealed a 10-mm echolucent space at the anterior uterine isthmus, confirming the diagnosis of isthmocele. The patient underwent hysteroscopic and robotic-assisted laparoscopic resection of the isthmocele. ICG fluorescence was utilized to enhance visualization during the procedure. ICG was prepared by mixing a 25 mg vial with 10 cc of sterile water to achieve a 2.5 mg/cc concentration, with 2 cc (5 mg) injected into the uterine cavity via syringe through the inflow port of the uterine manipulator 10 minutes before the surgical incision.
The surgical procedure was successful, with improved residual myometrial thickness observed in follow-up imaging. The patient reported resolution of AUB and pelvic pain two months post-surgery.
This case demonstrates that ICG imaging enhances defect localization and surgical precision, reducing operative time and complications. By optimizing the procedure and minimizing intraoperative challenges, ICG represents a significant advancement in isthmocele repair surgery, offering improved outcomes for complex uterine pathologies.
介绍一例43岁女性因子宫峡部缺损导致严重异常子宫出血（AUB）和慢性盆腔疼痛的病例，并展示吲哚菁绿（ICG）荧光在微创手术治疗中的有效性。
一名43岁女性，孕7产2052，尽管接受了包括非甾体抗炎药（NSAIDs）和激素治疗在内的多种保守治疗，但仍持续出现AUB和慢性盆腔疼痛，遂转诊接受子宫峡部缺损的手术治疗。患者表示希望避免子宫切除术。
术前评估包括二维经阴道超声（2D-TVUS）联合生理盐水灌注子宫输卵管造影（SIS），结果显示子宫峡部前壁有一个10毫米的无回声区，确诊为峡部缺损。患者接受了宫腔镜和机器人辅助腹腔镜下峡部缺损切除术。术中使用ICG荧光增强可视化效果。将25毫克小瓶与10毫升无菌水混合制备ICG，使其浓度达到2.5毫克/毫升，在手术切口前10分钟通过子宫操作器的流入端口经注射器向宫腔内注入2毫升（5毫克）。
手术成功，随访影像显示残余肌层厚度有所改善。患者术后两个月报告AUB和盆腔疼痛症状消失。
本病例表明，ICG成像可增强缺损定位和手术精度，减少手术时间和并发症。通过优化手术过程并将术中挑战降至最低，ICG代表了峡部缺损修复手术的重大进展，为复杂子宫病变提供了更好的治疗效果。
