Laser angiography with indocyanine green (ICG) to assess vaginal cuff perfusion during total laparoscopic hysterectomy (TLH): A pilot study.

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Laser angiography with indocyanine green (ICG) to assess vaginal cuff perfusion during total laparoscopic hysterectomy (TLH): A pilot study.

J Minim Invasive Gynecol. 2017 Jan 04;:

Authors: Beran BD, Shockley M, Arnolds K, Escobar P, Zimberg S, Sprague ML

Abstract
STUDY OBJECTIVE: To determine feasibility of using laser angiography with ICG to assess vaginal cuff vascular perfusion during TLH.
DESIGN: Pilot feasibility trial DESIGN CLASSIFICATION: Canadian Task Force Class 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 versus monopolar) and vaginal cuff closure suture (barbed versus non-barbed). Following intravenous administration of ICG, laser angiography was employed 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±S.D.) pre-closure, and 26.0±22.2 seconds post-closure. With ultrasonic energy, 67.5±17.4% (mean±S.D.) of open cuff perimeter, and 74.4±20.5% of closed cuff length were adequately perfused, while 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, while those closed with non-barbed suture showed 68.9±20.9% adequate perfusion. When normalized to cervical cup circumference, ultrasonic energy required 1.0±0.2 s/mm (mean±S.D.), while monopolar energy required 0.8±0.3 s/mm (p=0.162). Linear regression showed no association of normalized time of energy activation to percentage of perimeter of open cuff (R(2)=0.007) or length of closed cuff (R(2)=0.005) 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.

PMID: 28063908 [PubMed - as supplied by publisher]

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