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Fluorescence-guided laparoscopic inguinal hernia repair using indocyanine green angiography to prevent iatrogenic vascular injury: A case report and video.
Todeschini, Hernán; Dip, Fernando; Drago, Martin; White, Kevin P; Rosenthal, Raúl J; Sarotto, Luis.
Afiliación
  • Todeschini H; Departamento de Cirugía, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
  • Dip F; Departamento de Cirugía, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
  • Drago M; Departamento de Cirugía, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
  • White KP; SRI Health Research, London, Ontario, Canada.
  • Rosenthal RJ; Cleveland Clinic, Weston, FL, USA. Electronic address: rosentr@ccf.org.
  • Sarotto L; Departamento de Cirugía, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
Int J Surg Case Rep ; 123: 110203, 2024 Sep 12.
Article en En | MEDLINE | ID: mdl-39293222
ABSTRACT

INTRODUCTION:

Laparoscopic inguinal hernia repair (LIHR) is one of the most common surgical procedures performed worldwide, associated with a roughly 10 % rate of complications, most commonly iatrogenic injury to blood vessels, sometimes necessitating conversion to open surgery. Fluorescence-guided laparoscopic surgery using indocyanine green fluorescence angiography (ICG-FA) facilitates the precise identification of numerous anatomical structures, especially vascular, reducing their risk of iatrogenic injury. We present the first published case and video demonstrating LIHR with ICG-FA to prevent intra-operative vascular injury. PRESENTATION OF CASE A 46-year-old, otherwise-healthy male with a right inguinal hernia underwent fluorescence-guided LIHR using ICG-FA. Before peritoneal dissection, 2 ml ICG was administered intravenously, followed by 10 ml physiological solution. The surgical field was then illuminated using the Stryker fluorescence system. Once vascular structures were located, the sac was dissected. After reversing the peritoneum, but before placing the extraperitoneal mesh, another dose of ICG was administered intravenously to aid in safely securing the mesh. Both times after ICG injection, both the iliac artery and spermatic arteries were clearly visible throughout their course in the surgical field within 45 s. The hernia was repaired successfully with no complications.

DISCUSSION:

ICG-FA appears to facilitate inguinal hernia repair by enabling real-time visualization of anatomical structures, theoretically reducing the risk of complications, particularly vascular injuries. It is particularly helpful identifying the inguinal area's highly-vascular 'triangle of doom'.

CONCLUSIONS:

Further studies are warranted to evaluate short- and the long-term outcomes and cost-effectiveness of ICG-fluorescence angiography during laparoscopic inguinal hernia repair.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Surg Case Rep Año: 2024 Tipo del documento: Article País de afiliación: Argentina Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Surg Case Rep Año: 2024 Tipo del documento: Article País de afiliación: Argentina Pais de publicación: Países Bajos