Laparoscopic Paravaginal Repair with Fluorescent Vaginal Transillumination
AUTHORS:
Danielle Carr, MD (1,2,3,4), Peter Rosenblatt MD (1,2,3), Nicole Jenkins MD (5)
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INSTITUTIONS:
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Boston Urogynecology Associates, Cambridge, MA
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Mount Auburn Hospital, Cambridge, MA
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Harvard Medical School, Boston MA
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Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
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Department of Obstetrics and Gynecology, Hackensack Meridian Health, Neptune Township, NJ
Presented
International Urogynecologic Association (IUGA), June 2024
Objective
The goal of this video was to evaluate the utility of a near-infrared vaginal probe device in pelvic surgery, specifically in the retropubic space, and demonstrate surgical utilization of this instrument.
Introduction
Fluorescent guided surgery has been used in pelvic laparoscopy for a variety of purposes, including identification of sentinel lymph nodes, ureters, and the bladder. This process involves a fluorescent agent, usually an injectate, and a surgical system with near-infrared (NIR) capabilities. The light waves in the NIR spectrum are not absorbed by water, allowing them to penetrate deeper into tissues than the visible light spectrum. A novel vaginal probe has been recently developed and has the ability to transilluminate through the vaginal epithelium. One urogynecologic procedure that requires precise anatomic identification is the paravaginal repair, which may be performed in the retropubic space and is in close proximity of the bladder. Given the deep fluorescence penetration depth of the probe, we hypothesized this instrument would assist in clearly identifying the anatomic borders of the bladder and vaginal epithelium, allowing for a more confident and robust paravaginal repair.
Methods
A laparoscopic approach was taken to perform a paravaginal repair in a single case. A proprietary polymer-coated vaginal probe with fluorescence capability under near-infrared light was used in lieu of a regular vaginal probe or surgeon’s finger. The probe was used to identify vaginal tissue planes, and permanent sutures were placed over the probe.
Results
The green fluorescence of the vaginal probe was able to be appreciated with the near-infrared laparoscope and video system. This unique probe allowed for vaginal epithelium versus bladder tissue identification and more medial suture placement. A vaginal exam at the end of the procedure revealed excellent support and no suture material in the vagina. A cystoscopy was also performed and confirmed no suture material in the bladder and ureteral patency.
Conclusion
Use of the near-infrared technology assists in tissue plane distinguishment between the vagina and bladder in the retropubic space. This technique allows for a more medial placement of suture material on the vagina, thereby facilitating a more durable repair with better anatomic support. This technology has the potential to aid surgeons in making decisions, particularly in cases where discerning between tissue planes proves challenging.