Fluorescence-guided laparoscopic inguinal hernia repair using indocyanine green angiography to prevent iatrogenic vascular injury: A case report and video

• Published in: International journal of surgery case reports 2024-10, Vol.123, p.110203, Article 110203
• Main Authors: Todeschini, Hernán, Dip, Fernando, Drago, Martin, White, Kevin P., Rosenthal, Raúl J., Sarotto, Luis
• Format: Article
• Language: English
• Subjects: Case Report; Fluorescence-guided surgery; Hernia repair; Iatrogenic injury prevention; Indocyanine green; Inguinal hernia
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.110203

Laparoscopic inguinal hernia repair (LIHR) is one of the most common surgical procedures performed worldwide, associated with a roughly 10 % rate of complications, most commonly iatrogenic injury to blood vessels, sometimes necessitating conversion to open surgery. Fluorescence-guided laparoscopic surgery using indocyanine green fluorescence angiography (ICG-FA) facilitates the precise identification of numerous anatomical structures, especially vascular, reducing their risk of iatrogenic injury. We present the first published case and video demonstrating LIHR with ICG-FA to prevent intra-operative vascular injury. A 46-year-old, otherwise-healthy male with a right inguinal hernia underwent fluorescence-guided LIHR using ICG-FA. Before peritoneal dissection, 2 ml ICG was administered intravenously, followed by 10 ml physiological solution. The surgical field was then illuminated using the Stryker fluorescence system. Once vascular structures were located, the sac was dissected. After reversing the peritoneum, but before placing the extraperitoneal mesh, another dose of ICG was administered intravenously to aid in safely securing the mesh. Both times after ICG injection, both the iliac artery and spermatic arteries were clearly visible throughout their course in the surgical field within 45 s. The hernia was repaired successfully with no complications. ICG-FA appears to facilitate inguinal hernia repair by enabling real-time visualization of anatomical structures, theoretically reducing the risk of complications, particularly vascular injuries. It is particularly helpful identifying the inguinal area's highly-vascular ‘triangle of doom’. Further studies are warranted to evaluate short- and the long-term outcomes and cost-effectiveness of ICG-fluorescence angiography during laparoscopic inguinal hernia repair. •Vascular injury is not uncommon during laparoscopic inguinal hernia repair.•Fluorescence angiography with indocyanine green enhances visualization of vascular structures in the inguinal space, including the so-called “Triangle of Doom”, potentially reducing the incidence of iatrogenic vascular injury.•NIR guided surgery might increasethe confidece to the surgeon during the procedure and decrease the learning curve required for a safe procedure.