Indocyanine green colonic perfusion demonstration following robotic da Vinci X inferior mesenteric artery ligation for the treatment of type II endoleak

BACKGROUND: We describe the technical operative details of the robotic repair of a type II endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR). We demonstrate that indocyanine green (ICG) can be used intra‐operatively to demonstrate perfusion of the colon following ligation of the inferior mesenteric artery (IMA) vessel feeding the aneurysm sac. METHODS: A 74‐year old male underwent EVAR for a 5.8 cm infra‐renal abdominal aortic aneurysm using an E‐Tegra, Jotec Device (JOTEC Gmb, Lotzenäcker 23,D‐72379 Hechingen). Surveillance contrast CT (CTA) over the ensuing 30 months confirmed progressive sac expansion. RESULTS: ICG confirmed colonic perfusion via the marginals after IMA ligation. Total operative time 56 min < 50 mls blood loss and 1‐day hospital stay. 3‐month follow‐up: CTA and ultrasound demonstrated complete resolution of T2E and adequately perfused colon. CONCLUSION: A total robotic approach can be performed safely with intra‐operative ICG used to demonstrate colonic perfusion as an added safety measure.