ICG Enema to Make Rectal Shaving Easier and Safer

Abstract

Study Objective To use ICG enema to improve the surgical quality during rectal shaving. Design Surgical video. Setting Local GYN MIS hospital, single surgeon. Patients or Participants Patients with solitary rectal DIE nodule. Interventions After complete adhesiolysis and excision of all other pelvic endometriosis lesions except the rectal nodule, 12.5 mg ICG was diluted in 60 cc normal saline. The diluted ICG solution was injected into rectal lumen through anus and was retained in rectum (ICG enema) during the whole rectal shaving procedure. Measurements and Main Results After ICG enema, we started the rectal shaving procedure, carefully mapped the lesion margin, cut into rectal muscular layer with monopolar scissors under pure cutting mode. The submucosa layer can be easily recognized by the ICG green color. As long as we identified the green submucosa layer, we can easily stay precisely between the muscle layer and submucosa layer, keep the green submucosa and mucosa layer intact, with minimal risk of enterotomy. After rectal shaving, the muscular defect of the rectal wall can also be clearly identified by the exposed green submucosa layer. Rectal wall repair can then be confidently performed, transversely re-approximating the seromuscular layer, embedding all the green submucosa layer. Conclusion By ICG enema, staining the mucosa and submucosa layer with green ICG color, we can easily identify the submucosa layer during the rectal shaving procedure. The risk of enterotomy, and incomplete rectal wall repair after shaving can both be minimized. To use ICG enema to improve the surgical quality during rectal shaving. Surgical video. Local GYN MIS hospital, single surgeon. Patients with solitary rectal DIE nodule. After complete adhesiolysis and excision of all other pelvic endometriosis lesions except the rectal nodule, 12.5 mg ICG was diluted in 60 cc normal saline. The diluted ICG solution was injected into rectal lumen through anus and was retained in rectum (ICG enema) during the whole rectal shaving procedure. After ICG enema, we started the rectal shaving procedure, carefully mapped the lesion margin, cut into rectal muscular layer with monopolar scissors under pure cutting mode. The submucosa layer can be easily recognized by the ICG green color. As long as we identified the green submucosa layer, we can easily stay precisely between the muscle layer and submucosa layer, keep the green submucosa and mucosa layer intact, with minimal risk of enterotomy. After rectal shaving, the muscular defect of the rectal wall can also be clearly identified by the exposed green submucosa layer. Rectal wall repair can then be confidently performed, transversely re-approximating the seromuscular layer, embedding all the green submucosa layer. By ICG enema, staining the mucosa and submucosa layer with green ICG color, we can easily identify the submucosa layer during the rectal shaving procedure. The risk of enterotomy, and incomplete rectal wall repair after shaving can both be minimized.