Real-time indocyanine green fluorescent angiography in laparoscopic sigmoid vaginoplasty to assess perfusion of the pedicled sigmoid segment

OBJECTIVE: To assess the feasibility of intraoperative use of indocyanine green (ICG) fluorescent angiography in laparoscopic intestinal vaginoplasty to determine intestinal segment perfusion and viability.

DESIGN: Intestinal vaginoplasty may be performed as a vaginal (re)construction procedure. During surgery, a pedicled intestinal segment is transferred caudally to line the neovaginal cavity. Most commonly, a sigmoid or ileal segment is used. In obtaining adequate mobility of the segment, arterial structures sometimes have to be sacrificed, with possible detrimental effects on segment perfusion and subsequently viability. ICG may be used as an aid to assess segment perfusion. We present a case series of six consecutive patients who underwent intestinal vaginoplasty with intraoperative use of ICG.

SETTING: Tertiary university hospital.

PATIENT(S): Six transgender women undergoing laparoscopic sigmoid vaginoplasty with intraoperative use of ICG from October 2017 to October 2018.

INTERVENTION(S): Intraoperative use of ICG in laparoscopic sigmoid vaginoplasty to determine sigmoid segment perfusion and viability.

MAIN OUTCOME MEASURE(S): Value and feasibility of ICG in this reconstructive procedure.

RESULT(S): Intraoperative use of ICG demonstrated segment viability in five patients. In one patient, vascularization of the segment was deemed to be inadequate and reconstruction was aborted.

CONCLUSIONS: ICG fluorescent angiography may be used intraoperatively to assess perfusion of the pedicled sigmoid segment during sigmoid vaginoplasty.