Intra-operative near-infrared fluorescence imaging of the bowel during endometriosis surgery with indocyanine green: a pilot study

Rationale: The distinction between endometriotic tissue and healthy tissue is difficult. Removal of bowel endometriosis can be done via shaving, discoid resection or segmental resection. While shaving results in the least complications, segmental resection results in the lowest recurrence rates. One could potentially use shaving for more patients, with more complete resection, if endometriosis visibility is optimized. Fluorescence with indocyanine green could be used for this purpose in bowel endometriosis, as the bowel is highly vascularized and therefore fluorescent, compared to the fibrotic endometriotic nodule.
Objective: The primary objective is to assess the feasibility to detect the border between healthy – and therefore fluorescent- bowel and endometriosis by using intravenous indocyanine green. This is measured by the difference in border between the assessment with ICG compared to conventional laparoscopic white light assessment.

By administering ICG, the bowel will be fluorescent, as it is highly vascularized. As the endometriotic nodule contains fibrosis, the nodule will be less fluorescent compared to the bowel. Using this difference, the border between endometriosis and healthy bowel can be determined more precisely compared to conventional surgery.

Tissue perfusion will be assessed directly after injection of ICG.

All patients will receive a repeated dose of 5 mg ICG at two moments