Laser Angiography with Indocyanine Green to Assess Vaginal Cuff Perfusion during Total Laparoscopic Hysterectomy: A Pilot Study
| Autor: | Marie E. Shockley, Stephen E. Zimberg, Pedro F. Escobar, Katrin Arnolds, Benjamin Beran, M.L. Sprague |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Indocyanine Green medicine.medical_specialty Pilot Projects Colpotomy Hysterectomy Perimeter 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Suture (anatomy) Hysterectomy Vaginal Humans Medicine Prospective Studies 030212 general & internal medicine Pelvis Aged 030219 obstetrics & reproductive medicine Sutures medicine.diagnostic_test business.industry Lasers Angiography Obstetrics and Gynecology Middle Aged Surgery Treatment Outcome medicine.anatomical_structure Barbed suture chemistry Cuff Feasibility Studies Female Laparoscopy business Indocyanine green Perfusion |
| Zdroj: | Journal of Minimally Invasive Gynecology. 24:432-437 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2016.12.021 |
| Popis: | Study Objective To determine feasibility of using laser angiography with indocyanine green (ICG) to assess vaginal cuff vascular perfusion during total laparoscopic hysterectomy (TLH). Design Pilot feasibility trial (Canadian Task Force classification II-2). Setting Academic-affiliated hospital. Patients Twenty women undergoing TLH for benign disease. Interventions Participants underwent 1:1 randomization of energy method used for colpotomy (ultrasonic vs monopolar) and vaginal cuff closure suture (barbed vs nonbarbed). After intravenous administration of ICG, laser angiography was used to capture images of the vaginal cuff before and after closure. Three reviewers analyzed fluorescent images of vaginal cuffs to determine percent of cuff perimeter with adequate perfusion when open and length of vaginal cuff adequately perfused when closed. Measurements and Main Results ICG fluorescence was visible at the vaginal cuff in all participants. Mean time to appearance of ICG in the pelvis after administration was 19.8 ± 6.8 seconds (mean ± SD) preclosure, and 26.0 ± 22.2 seconds postclosure. With ultrasonic energy 67.5% ± 17.4% of open cuff perimeter and 74.4% ± 20.5% of closed cuff length were adequately perfused, whereas with monopolar energy use 59.1% ± 17.4% of the open cuff perimeter and 66.3% ± 15.4% of closed cuff length were adequately perfused. Cuffs closed with barbed suture showed adequate perfusion along 71.5% ± 15.1% of the length, whereas those closed with nonbarbed suture showed 68.9% ± 20.9% adequate perfusion. When normalized to cervical cup circumference, ultrasonic energy required 1.0 ± .2 s/mm, whereas monopolar energy required .8 ± .3 s/mm (p = .162). Linear regression showed no association of normalized time of energy activation to percentage of perimeter of open cuff (R 2 = .007) or length of closed cuff (R 2 = .005) with adequate perfusion. No complications related to intravenous ICG administration occurred. Conclusion Laser angiography with ICG allows evaluation of vascular perfusion at the vaginal cuff during TLH. This technique may facilitate future prospective studies examining causes for vaginal cuff dehiscence, a complication with potential for severe morbidity. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|