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Case Reports
. 2022 Aug;18(4):e2407.
doi: 10.1002/rcs.2407. Epub 2022 Apr 23.

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

Joel Lambert  1   2   3 , Sulaymaan Al Majid  4 , Robert Salaman  1 , Duncan Gavan  1 , Adnan Sheikh  1   3 , Michael Gill  1   3
Affiliations
Case Reports

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

Joel Lambert et al. Int J Med Robot. 2022 Aug.

Abstract

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.

Keywords: Da Vinci X; indocyanine green; robotic surgery; vascular endoleak.

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Conflict of interest statement

For all the authors, the submitted work was not carried out in the presence of any personal, professional or financial relationships that could potentially be construed as a conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) dissection of inferior mesenteric artery (IMA). (B)Application of bulldog clip to check perfusion. (C) Selective ligation of IMA using Smartfire stapling device. (D) Post‐ligation of IMA, aneurysm sac visible in the bottom of image
FIGURE 2
FIGURE 2
(E) Indocyanine green (ICG) perfusion after bulldog clip applied. (F) perfusion of left colon
FIGURE 3
FIGURE 3
(G) Preoperative CTA with persistent T2E. (H) Postoperative CTA with type II endoleak (T2E) resolved. (I) Preoperative CEUS with inferior mesenteric artery (IMA) filling of sac. (J) Postoperative CEUS with resolved IMA filling
See this image and copyright information in PMC

References

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