OBJECTIVE To evaluate the feasibility of using indocyanine green (ICG) to estimate the vascularization of the resected zone during a laparoscopic rectal shaving. DESIGN Indocyanine green can highlight blood vascularization when injected intravenously. There is no relevant, objective, intraoperative method to assess the vascularity of the resected zone during a laparoscopic rectal shaving for deep infiltrating endometriosis (DIE) to prevent fistula. We conducted a registered clinical trial examining the feasibility of the use of ICG to evaluate the bowel vascularization after endometriosis rectal shaving (Institutional Review Board number 2016-002773-35). SETTING Tertiary university hospital. PATIENT(S) Twenty-one patients underwent laparoscopic surgery for DIE with a rectal shaving. INTERVENTION(S) Patients undergoing laparoscopic surgery for DIE received ICG intravenously at the end of the endometriosis resection. MAIN OUTCOME MEASURE(S) The main evaluation criteria was the fluorescence degree in the operated rectal area and in the vaginal suture. We used a visual assessment with a Likert-type scale from 0 to 4 (0 = no fluorescence; 4 = very good fluorescence). RESULT(S) No adverse reaction was recorded. Most of the patients (81%) showed very good fluorescence levels at the rectal shaving area. The protocol did not increase the operating time. In one patient we changed the surgical strategy making two stitches to bring the rectal muscularis closer together, which improved the degree of fluorescence. There was no case of digestive fistula. CONCLUSION Indocyanine green fluorescent imaging is feasible in endometriosis surgery and may be considered as a potential candidate to further enhance patient safety in endometriosis bowel surgery. CLINICAL TRIAL REGISTRATION NUMBER NCT03080558.

中文翻译：

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深部浸润性子宫内膜异位症中的吲哚菁绿：直肠剃须后血管形成的初步可行性研究

目的 评估在腹腔镜直肠剃须期间使用吲哚菁绿 (ICG) 评估切除区血管化的可行性。设计 吲哚菁绿静脉注射时可以突出血管化。没有相关的、客观的、术中方法来评估在腹腔镜直肠剃须治疗深层浸润性子宫内膜异位症 (DIE) 期间切除区的血管分布，以预防瘘管。我们进行了一项注册临床试验，检查使用 ICG 评估子宫内膜异位症直肠剃须后肠道血管化的可行性（机构审查委员会编号 2016-002773-35）。设置第三大学医院。患者 21 名患者接受了腹腔镜手术治疗 DIE，并进行了直肠剃须。干预措施 接受腹腔镜手术治疗 DIE 的患者在子宫内膜异位症切除术结束时静脉注射 ICG。主要观察指标主要评价标准是手术直肠区和阴道缝合处的荧光度。我们使用从 0 到 4 的李克特型量表进行视觉评估（0 = 无荧光；4 = 非常好的荧光）。结果(S) 没有记录到不良反应。大多数患者 (81%) 在直肠剃须区域显示出非常好的荧光水平。该协议没有增加操作时间。在一名患者中，我们改变了手术策略，缝了两针，使直肠肌层靠得更近，从而提高了荧光程度。无消化瘘病例。结论吲哚菁绿荧光成像在子宫内膜异位症手术中是可行的，可被视为进一步提高子宫内膜异位症肠道手术患者安全性的潜在候选者。临床试验注册号 NCT03080558。