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Near Infrared Fluorescence During Minimally Invasive Sacrocolpopexy: A Pilot Study

AUTHORS:

Dr. Joseph Panza, Dr. Diego Hernandez, Dr. Ashley Gubbels, Dr. Jenifer Byrnes

Objective

The objective of this video is to review near infrared (NIR) fluorescence assisted surgical applications and discuss results of our pilot study using fluorescent vaginal/rectal manipulators during minimally invasive sacrocolpopexy. 

Methods

For background, the video contains information on fluorescence guided surgery and transitions into gynecologic applications.  The potential for fluorescence assisted surgery to minimize surgical complications such as bladder perforation during sacrocolpopexy was inspiration for the development of fluorescent surgical manipulators. The prototype devices under study were developed with an FDA approved proprietary polymer that fluoresces under NIR imaging.  It does not require batteries or electricity.  The devices were fashioned after a 30mm end-to-end anastomosis sizer for rectal/vaginal manipulation and a 1 ½”lucite rod for vaginal manipulation.  IRB approval was obtained for these surgical pilot studies evaluating the surgical and educational utility of a fluorescent vaginal/rectal manipulator.

Results

Twenty subjects were enrolled.  The manipulator was inserted vaginally/rectally and the NIR mode was used during bladder and/or rectal dissection as well as mesh placement.  All surgeries were performed without complication.  The vaginal/rectal manipulators fluoresced in NIR mode and the tissue was transilluminated.  The ability to transilluminate the tissue provided additional information to the surgeon.  For example, surgical planes and scar tissue were enhanced.  With improved visualization, there is a potential to decrease bladder perforation complications and improve communication with surgical learners.

Conclusion

Fluorescent vaginal/rectal manipulators transilluminated the tissue allowing for more real time visual information and better surgical decision making; in addition, it increased communication between surgical teacher and learner as anatomic borders and surgical planes were highlighted with the fluorescence.

References

  1.  Fluorescence Guided Surgery: A Nurses Guide to ICG. Pfiedler Education. 2020.

  2. Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547 e1-8.

  3. Wen Q, Zhao Z, Wen J, Yang Y, Wang L, Wu J, et al. Impact of obesity on operative complications and outcome after sacrocolpopexy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;258:309-16.

  4. Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynaecol Obstet. 2016;132(3):284-91.

  5. Akl MN, Long JB, Giles DL, Cornella JL, Pettit PD, Chen AH, et al. Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc. 2009;23(10):2390-4.