Indocyanine green application during robotic uterine transposition and repositioning.

OBJECTIVE

To demonstrate the steps of robotic uterine transposition and repositioning and the use of indocyanine green (ICG) tracers to verify uterine perfusion during robotic uterine transposition and repositioning with a fluorescence imaging system. To our knowledge, a total of 25 patients who underwent uterine transposition have been reported in the literature. However, uterine necrosis has been reported after uterine transposition. It is prudent to verify uterine perfusion during uterine transposition.

DESIGN

Video article.

SUBJECTS: A 23-year-old nulliparous woman with stage IIIA rectal adenocarcinoma was scheduled to receive radiotherapy and chemotherapy. The patient included in this video gave consent for publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.), and other applicable sites.

EXPOSURE: A robotic system (da Vinci Si Surgical System; Intuitive Surgical Inc., Sunnyvale, CA) without a built-in fluorescence imaging system was used. Uterine perfusion was verified by intravenous administration of an ICG tracer and visualization of the colored uterus using an endoscopic fluoroscopic imaging system (PINPOINT; Novadaq, Mississauga, Canada) in the assistant port.

MAIN OUTCOME MEASURES: Visualization of uterine perfusion after uterine transposition and repositioning.

RESULTS

Uterine perfusion could be easily demonstrated via ICG injection. The uterine transposition and repositioning processes were uneventful. No evidence of uterine necrosis or cervical ischemia was observed during follow-up.

CONCLUSION

Intravenous administration of ICG is a good and simple method for verifying uterine perfusion during uterine transposition and repositioning.