case_images: PMC11300066_01
case_images: MRI of the pelvis. (a, b) Large leiomyoma arising anteriorly from the body and cervix of the uterus, measuring 150 x 130 x 150 mm, with central cystic and necrotic changes and displacement of the uterus left posteriorly. Multiple smaller fibroids up to 25 x 20 mm and mild distension and dilatation of both ureters also seen.
case_images: CRIOG2024-1642315.001.jpg
case_images: PMC11300066_01_CRIOG2024-1642315.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging confirmed a 150 x 130 x 150 mm leiomyoma with central cystic change causing displacement of the uterus left posteriorly and mild distention and dilatation of both ureters (Figure 1).
case_images: Intraoperative images for Case 1. (a, b) ICG was administered into the ureters bilaterally using cystoscopy and ureteral catheterisation. (c, d) Initial laparoscopic views were obstructed by the large multifibroid uterus filling the pelvic cavity. (e, f) ICG in the ureters illuminated their path on laparoscopic view.
case_images: CRIOG2024-1642315.002.jpg
case_images: PMC11300066_01_CRIOG2024-1642315.002.jpg
case_images: fig2
case_images: During the surgery, 5 ml of diluted ICG was administered bilaterally into the ureters using cystoscopy and ureteral catheterisation (Figures 2(a) and 2(b)). As anticipated, the initial laparoscopic views were obstructed by a sizable uterus that filled the entire pelvic cavity, complicating the visualisation of crucial anatomical structures (Figures 2(c) and 2(d)). Nonetheless, the employment of ICG to illuminate the ureters allowed for their safe and efficient dissection (Figures 2(e) and 2(f)).
case_images: PMC11300066_02
case_images: Deep infiltrative endometriosis scans. (a) Enlarged left ovary measuring 90 x 94 x 69 mm with (b) an associated ovarian endometrioma measuring 88 x 68 x 56 mm situated in the Pouch of Douglas. Scans also revealed bowel involvement, with (c) a free-lying loop of bowel tethered to the endometrioma at 160 mm from the anal verge, measuring 10 x 3 x 7 mm.
case_images: CRIOG2024-1642315.003.jpg
case_images: PMC11300066_02_CRIOG2024-1642315.003.jpg
case_images: fig3
case_images: A deep infiltrative endometriosis scan confirmed an enlarged left ovary at 90 x 94 x 69 mm (Figure 3(a)) with an ovarian endometrioma extending into the Pouch of Douglas measuring 88 x 68 x 56 mm (Figure 3(b)). In addition, the scans revealed bowel involvement, with a free-lying loop of bowel tethered to the endometrioma (Figure 3(c)), as well as concurrent widespread adenomyosis.
case_images: Intraoperative images for Case 2. (a, b) ICG in the ureters illuminated their path on laparoscopic view. (c, d) Vaginal administration of ICG allowed bright fluorescence of the vagina (white arrow), facilitating its delineation from the rectum (yellow arrow) during the surgery.
case_images: CRIOG2024-1642315.004.jpg
case_images: PMC11300066_02_CRIOG2024-1642315.004.jpg
case_images: fig4
case_images: On laparoscopic view, the ureters and vagina were brightly illuminated by ICG, allowing their continued visualisation throughout the surgery (Figure 4). In particular, the dissection of the rectal endometrial deposits was facilitated by the fluorescence of ICG in the vagina (Figures 4(c) and 4(d)), which enabled a high level of precision with optimal preservation of healthy tissue.