Angiografia a fluorescenza con verde di indocianina durante chirurgia radicale e conservativa per endometriosi retto-sigmoidea: studio prospettico di fattibilità

Objective: To evaluate feasibility and safety of near-infrared indocyanine green (NIR-ICG) imaging for bowel vascularization assessment after minimally invasive conservative and radical excision of recto-sigmoid endometriosis (RSE). Materials and methods: Prospective, monocentric, preliminary study on consecutive symptomatic patients scheduled for minimally invasive surgical excision of RSE from May 2018 to January 2020 at the Sant’Orsola University Hospital in Bologna. Fluorescence degree of the bowel resected area was evaluated through NIR-ICG evaluation using a three-point Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (non-uniform or weak fluorescence) and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). The primary outcome of this study was the protocol completion rate. Secondary outcomes included protocol time, inter-operator agreement, peri-operative complications and any changes in the surgical strategy adopted. Results: During the study period, 46 patients who met the eligibility criteria were enrolled in the study. In all cases NIR-ICG protocol was successfully performed. Forty-five (97.8%) cases showed regular fluorescence (Likert 2 scale); in one patient (2.2%) with irregular fluorescence after discoid excision, we changed the surgical strategy reinforcing anastomotic suture. No complications related to the use of ICG were recorded. Median protocol time was 4 (range, 3-5) minutes. Excellent inter-operator agreement was observed. Conclusion: NIR-ICG imaging for bowel perfusion evaluation after RSE surgery appears to be a feasible, safe and reproducible method. Further prospective studies are needed to evaluate its efficacy in reducing morbidity associated with colorectal surgery for RSE.