Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy

Abstract

Objectives The aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy. Methods Data were collected from all patients diagnosed with early-stage cervical cancer that underwent laser angiography with ICG during open or laparoscopic radical trachelectomy from June 2012 to December 2015. Regression analysis was use to determine the p values and R-squares on fluorescence, surgical time, hospital stay, age and BMI; a p-value < 0.05 was considered statistically significant. Results A total of 20 patients met the inclusion criteria and were included in this study. Ten patients underwent uterine artery-sparing surgery, and ten patients underwent uterine artery non-sparing surgery. The most frequent stage for the entire cohort was IA2 (55%), and the most common histologic subtype was squamous cell carcinoma (49%). Lymph-vascular invasion was noted in 30% of the patients. There was no statistical significance difference in the mean ICG fundal fluorescence intensity between the uterine artery-sparing group 162.5 (range, 137-188) and the uterine artery non-sparing group 160.5 (range, 135-186), p=0.22. In both groups, 100% of the patients regained their menstrual function by postoperative week 8. A total of 4 (40%) pregnancies have occurred in the uterine artery-sparing group and 3 (30%) in the non-uterine artery-sparing group. Conclusions Based on our real-time intraoperative angiography observations, there is no need to preserve the uterine artery during radical trachelectomy to maintain uterine viability.

Uterine viability in the baboon after ligation of uterine vasculature: a pilot study to assess alternative perfusion and venous return for uterine transplantation

“…Data on the benefits of preserving the uterine artery is very heterogeneous and not always reported in the literature. Nevertheless, the great majority of radical trachelectomy patients resume menses postoperatively, and multiple groups have reported subsequent pregnancies, regardless of whether the uterine artery was spared (6)(7)(8)(9). These studies substantiated our hypothesis that utero-ovarian vasculature alone could maintain uterine viability.…”

Intra- and Postoperative Blood Flow Monitoring in a Sheep Model of Uterus Transplantation

“…ICG angiography is used in a range of surgeries, such as for free flaps e.g. in head and neck surgery (35), in the field of upper extremity surgery (36), for assessing parathyroid perfusion during thyroidectomy (37), for breast reconstruction (38), but also for uterine vascular perfusion at the time of radical trachelectomy (39) and organ transplantations (40). Beran et al used ICG after cervico-vaginal anastomosis in baboons to document real-time vascular perfusion of the uterus with utero-ovarian perfusion alone (41,42).…”

Indocyanine green angiography for preserving the ureteral branch of the uterine artery during radical hysterectomy

“…[ 9 ] It has also been used to analyze uterine perfusion during uterine artery-sparing radical trachelectomy. [ 5 ]…”

“…[ 2 , 4 ] We are unaware of studies in which this approach is guided by intraoperative imaging techniques. Taking advantage of the recent use of indocyanine green (ICG) intraoperative imaging to assess uterine blood flow and perfusion, [ 5 ] we decided to apply the same technique to ureteral branch-sparing radical hysterectomy. Here we describe 2 cases in which we observed, in real time, perfusion of the uterine artery, its ureteral branch and the ureter using ICG fluorescence angiography.…”