Experience with fluorescence imaging in robot-assisted treatment of deep genital endometriosis using the da Vinci surgical system

Background. Development of robot-assisted technologies allowed to significantly increase accuracy of surgical interventions. However, with all of the benefits of the da Vinci robotic surgical system, assessment of endometriosis lesion growth into the surrounding tissues is complicated even during robot-assisted treatment. This problem can be solved by using fluorescent navigation with indocyanine green.

Aim. To evaluate the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci robotic surgical system and fluorescence imaging of the surgical field.

Materials and methods. Data of 39 patients who underwent surgery at the N.I. Pirogov National Medical and Surgical Center, Ministry of Health of Russia, between 2023 and 2025 were analyzed. Operative and hospitalization times, blood loss volume, intra- and postoperative complication rates, number of identified and histologically confirmed “hidden” endometriosis lesions invisible during surgery in standard white light, duration of adequate staining of endometriosis-affected tissues during fluorescent visualization, clinical disease course in the postoperative period were analyzed.

Results. Mean blood loss volume was 179.5 ± 116.6 mL, mean operative time was 238 ± 147.3 min. In all patients, 15–30 min after intravenous infusion of indocyanine green, endometriosis lesions were stained green with sharp boundaries. Adequate lesion staining persisted for 49.7 ± 16.0 min. In 29 (74.4 %) cases, fluorescent visualization allowed to identify residual endometriosis lesions invisible in white light; they were sent for histological examination (60 samples) which confirmed endometrioid nature of 51 (85 %) samples. Postoperative complication (intraabdominal hemorrhage from the area of trocar port) was observed in 1 (2.6 %) patient on day 2 after surgery. Mean hospitalization time was 7.1 ± 2.8 days. At the time of examination 12 months after treatment, the patients reported disappearance of pelvic pain, dysmenorrhea, hyperpolymenorrhea, and dyspareunia. No signs of recurrent external genital endometriosis were found.

Conclusion. High diagnostic value of intraoperative visualization with indocyanine green allowing for timely correction of surgery and minimization of the risk of incomplete endometriosis lesion excision was demonstrated.

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