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Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy
BACKGROUND AND OBJECTIVES: Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiog...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society of Laparoendoscopic Surgeons
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016861/ https://www.ncbi.nlm.nih.gov/pubmed/29950801 http://dx.doi.org/10.4293/JSLS.2018.00001 |
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author | Beran, Benjamin D. Shockley, Marie Padilla, Pamela Frazzini Farag, Sara Escobar, Pedro Zimberg, Stephen Sprague, Michael L. |
author_facet | Beran, Benjamin D. Shockley, Marie Padilla, Pamela Frazzini Farag, Sara Escobar, Pedro Zimberg, Stephen Sprague, Michael L. |
author_sort | Beran, Benjamin D. |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH. METHODS: This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or nonbarbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion. RESULTS: Indocyanine green (ICG) was visible at the vaginal cuff in all participants. Optimal dosage was determined to be 7.5 mg of ICG per intravenous dose. Mean time to appearance for ICG was 18.4 ± 7.3 s (mean ± SD) before closure and 19.0 ± 8.7 s after closure. No significant difference (P = .19) was noted in judged perfusion in open cuffs after colpotomy with a monopolar (48.9 ± 26.0%; mean ± SD) or ultrasonic (40.2 ± 14.1%) device. No difference was seen after cuff closure (P = .36) when a monopolar (70.9 ± 21.1%) or ultrasonic (70.5 ± 20.5%) device was used. The use of barbed (74.1 ± 20.1%) or nonbarbed (66.4 ± 20.9%) sutures did not significantly affect estimated closed cuff perfusion (P = .19). Decreased cuff perfusion was observed with longer instrument activation times in open cuffs (R(2) = 0.3175). CONCLUSION: Laser angiography during RATLH allows visualization of vascular perfusion of the vaginal cuff. The technology remains limited by the lack of quantifiable fluorescence and knowledge of clinically significant levels of fluorescence. |
format | Online Article Text |
id | pubmed-6016861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Society of Laparoendoscopic Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-60168612018-06-27 Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy Beran, Benjamin D. Shockley, Marie Padilla, Pamela Frazzini Farag, Sara Escobar, Pedro Zimberg, Stephen Sprague, Michael L. JSLS Scientific Paper BACKGROUND AND OBJECTIVES: Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH. METHODS: This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or nonbarbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion. RESULTS: Indocyanine green (ICG) was visible at the vaginal cuff in all participants. Optimal dosage was determined to be 7.5 mg of ICG per intravenous dose. Mean time to appearance for ICG was 18.4 ± 7.3 s (mean ± SD) before closure and 19.0 ± 8.7 s after closure. No significant difference (P = .19) was noted in judged perfusion in open cuffs after colpotomy with a monopolar (48.9 ± 26.0%; mean ± SD) or ultrasonic (40.2 ± 14.1%) device. No difference was seen after cuff closure (P = .36) when a monopolar (70.9 ± 21.1%) or ultrasonic (70.5 ± 20.5%) device was used. The use of barbed (74.1 ± 20.1%) or nonbarbed (66.4 ± 20.9%) sutures did not significantly affect estimated closed cuff perfusion (P = .19). Decreased cuff perfusion was observed with longer instrument activation times in open cuffs (R(2) = 0.3175). CONCLUSION: Laser angiography during RATLH allows visualization of vascular perfusion of the vaginal cuff. The technology remains limited by the lack of quantifiable fluorescence and knowledge of clinically significant levels of fluorescence. Society of Laparoendoscopic Surgeons 2018 /pmc/articles/PMC6016861/ /pubmed/29950801 http://dx.doi.org/10.4293/JSLS.2018.00001 Text en © 2018 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way. |
spellingShingle | Scientific Paper Beran, Benjamin D. Shockley, Marie Padilla, Pamela Frazzini Farag, Sara Escobar, Pedro Zimberg, Stephen Sprague, Michael L. Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title_full | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title_fullStr | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title_full_unstemmed | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title_short | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy |
title_sort | laser angiography to assess the vaginal cuff during robotic hysterectomy |
topic | Scientific Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016861/ https://www.ncbi.nlm.nih.gov/pubmed/29950801 http://dx.doi.org/10.4293/JSLS.2018.00001 |
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