Bladder Endometriosis Fluorescence-Guided Surgery - A Case Report

Study Objective

Describe a complex case of a patient with a large bladder endometriosis nodule with surgical excision guided by indocyanine green (ICG).

Design

Narrated surgical video discussing the surgical technique to excise a large bladder endometriosis nodule using indocyanine green to guide the dissection. This video highlights indocyanine green as a useful tool in a complex case of endometriosis as well as, identification of important anatomical landmarks for this type of procedure

Setting

Tertiary academic center. The patient was positioned in semi-gynecological position for the procedure. A 10 mm port was placed on the umbilicus, and 3 auxiliary ports were placed following the triangulation technique.

Patients or Participants

32-years-old woman with dismenorrhea for 5 years, and occasional dysuria, with no improvemnt with LNG-IUD. On physical examination, she had a 2-cm palpable nodule on the retrocervical area. Her transvaginal ultrassound showed, bladder nodule with infiltration into the submucosa, as well as her RMI showed a perivesical peritoneal lesion with infiltration of the detrusor muscle, and anterior myometrium. The urodynamic study demonstrated reduced bladder complacency.

Interventions

The patient underwent cystoscopy with ureteral catheterization with indocynine green injection. A laparoscopy was performed for the excision of the endometriosis with removal of the bladder nodule after vesico-uterine space dissection, guided by ICG. Adjacent myometrium was removed to decrease the risks of recurrence. The bladder was then sutured.

Measurements and Main Results

The procedure was completed without any complications. Endometriosis were confirmed through the pathology report. The patient reported a complete improvement of her symptoms after 6-month of follow up.

Conclusion

The technique performed in the video demonstrates the benefit of using ICG, identifying anatomical landmarks and limits, ensuring complete resection of bladder endometriosis, as well as reducing postoperative complications.