Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

(1) Background: The surgical treatment (ST) of deep infiltrating endometriosis (DIE) presents technical difficulties and pitfalls. Surgeon’s experience and new technologies reduce the difficulty of identifying endometriosis lesions especially if small or hidden. Recently, the near-infrared technology with indocyanine green (NIR-ICG) associated with the standard vision in white light (WL) resulted useful in order to improve ST of DIE. The aim of this video-article is to show the utility of NIR-ICG during surgery for DIE. (2) Methods: During surgery the whole abdomen and pelvis are upfront visually inspected using normal WL vision than after intravenous ICG injection in NIR mode. All suspected areas for endometriosis in WL and fluorescent in NIR-ICG are removed and analyzed at pathology. (3) Results: This is the case of a fertility-desiring 43 years old woman affected by DIE and planned for ST. NIR-ICG enabled the Surgeon to have an intraoperative confirmation of endometriosis lesions already visualized in WL, permitted moreover to better identify other endometriosis localizations not clearly pathologic in the WL vision and also enabled to more easily distinguish endometriosis localizations from adjacent healthy-tissues. (4) Conclusion: NIR-ICG can support the Surgeon with an intra-operative confirmation of already identified suspected lesions and it facilitates to identify unnoticed or hidden lesions achieving greater radicality in ST for DIE.