Intraoperative Indocyanine Green Dye Use in Ovarian Torsion: A Feasibility Study

Abstract

To determine the feasibility of intravenous indocyanine green (ICG)dyeuse inpatients withadnexal torsion to intraoperatively evaluate ovarian perfusion after detorsion. A prospective multicenter single-arm feasibility study. A teaching hospital. A total of 12 nonpregnant patients, 18 to 45 years old with surgically confirmed adnexal torsion. Torsion was surgically confirmed, the involved adnexa were untwisted laparoscopically, and ICG dye was injected intravenously. The absence or presence of ICG perfusion was documented, and the clinical decision for ovarian conservation or removal was determined by the surgeon. The primary outcome was feasibility of using ICG dye including measures such as time to visualized perfusion and operative time. Secondary outcomes included presence or absence of ovarian preservation and postoperative follow-up measures. Intraoperative visualization of ICG perfusion to the detorsed adnexa was achieved in 10 patients (83%) in a median time of 1 minute (0, 2), resulting in entire (n=9) or partial (n=1) ovarian conservation. Perfusion was absent in 2 cases, and postoophorectomy histologic necrosis was confirmed in one case. Median operative time was 74 minutes (48, 94). There were no adverse events related to ICG dye use. Intraoperative ICG dye use in this study was logistically feasible and conservation of the entire or partial ovary was observed in 83% of patients, including one case where preoperative Doppler flow was absent.