Indocyanine Green tattooing for marking the caudal excision margin of a full-thickness vaginal endometriotic nodule

BACKGROUND: The use of Indocyanine Green (ICG) is well-described in oncology and more recently in benign gynaecological surgery. In this article we describe submucosal transvaginal ICG infiltration caudal to a vaginal endometriotic nodule to visualise the lower margin of excision laparoscopically. OBJECTIVES: To demonstrates the use of submucosal ICG tattooing to mark and delineate the caudal margin of an ultra-low full thickness vaginal nodule and aid its excision laparoscopically. MATERIAL AND METHODS: A stepwise approach highlighting the “SOSURE” surgical technique for the excision of endometriosis and the practical use of the ICG to delineate the lowest margin of the full thickness vaginal nodule. MAIN OUTCOME MEASURES: Laparoscopic complete excision of a 5 cm full-thickness vaginal nodule invading the right parametrium and involving the superficial muscularis layer of the rectum. RESULT: ICG tattooing was helpful in identifying the lower margin of dissection of the rectovaginal space. CONCLUSION: ICG tattooing of the margins of full-thickness vaginal nodules could be another use of ICG in benign gynaecology to complement the surgeon’s tactile and visual identification of the lower edge of dissection.