Near Infrared Fluorescent Manipulator During Minimally Invasive Sacrocolpopexy: A Pilot Study

Abstract Objective: The objective of this paper is to evaluate fluorescent guided surgery using a near infrared (NIR) fluorescent vaginal/rectal manipulator during minimally invasive sacrocolpopexy. Methods: This was a pilot study of fluorescent pelvic manipulators in women undergoing previously scheduled reconstructive pelvic surgery. Subjects were eligible if a traditional 30mm end-to-end anastomosis (EEA) sizer was planned for use during the participant’s surgery. The prototype devices under study were developed with a patent protected polymer that fluoresces under NIR imaging. Measurement outcomes include subjective feedback from the surgical team, the frequency in which the surgeon reverted back to a traditional steel manipulator, adverse intraoperative complications and video documentation of findings. Results: Twenty subjects were enrolled. The fluorescent manipulator could be visualized through vaginal/rectal tissue in all surgeries and no intraoperative complications were noted. The surgeons continued with the fluorescent manipulator, over the traditional manipulator, in 100% of the cases. Subjectively, the operating staff noted improved communication, increased confidence in the surgical learner and enhanced visualization of the anatomy. On review of the videos, fluorescent NIR transillumination of the tissue highlighted anatomic distortion in 60% of the available videos. Conclusion: Fluorescent vaginal/rectal manipulators transilluminated the tissue allowing for real time visual information and better surgical decision making; in addition, it increased communication between surgical teacher and learner as anatomic borders and surgical planes were highlighted with fluorescence. With improved visualization, there is a potential to decrease unintentional perforations, reduce operating room time and improve communication with surgical learners and surgical team members.