Ovarian conservation in a patient with a large ovarian cyst and adnexal torsion – a confirmatory video with intravenous indocyanine green

Ovaries recover even after multiple and long-lasting twists of the infundibulo-pelvic ligament.
Ovarian conservation in a patient with a large ovarian cyst and adnexal torsion – a confirmatory video with intravenous indocyanine green
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VOLUME 118, ISSUE 2, P417-418

Authors:

Maximilian Klar, M.D., M.P.H., Koji Matsuo, M.D., Ingolf Juhasz-Böss, M.D., Mir-Fuad Hasanov, M.D.

Abstract:

Objective

To share our experience of intravenous indocyanine green (ICG) application during conservative ovarian surgery in a young patient with adnexal torsion, a large ovarian cyst, and apparent ovarian necrosis.


Design

This confirmatory video of ovarian reperfusion uses footage from the laparoscopic treatment and ICG application in a young patient with adnexal torsion and apparent necrosis.


Setting

Academic, multisite medical center.


Patient(s)

A 24-year-old patient with a 12-cm dermoid cyst, adnexal torsion, and apparent tissue necrosis.


Intervention(s)

Five milligrams intravenous ICG, de-torsion, ovarian cystectomy, and ovarian reconstruction. The patient approved the ICG off-label use.


Main Outcome Measure(s)

Ovarian preservation and perioperative morbidity.


Result(s)

This video demonstrates the surgical treatment of a patient with adnexal torsion. The perfusion patterns before and after the surgical treatment, i.e., cyst de-torsion and cyst removal are documented using intravenous ICG. The perfusion patterns guided the surgeon to perform ovarian conservation despite apparent initial ischemia. The patient recovered well, and no postoperative 30-day morbidity occurred.


Conclusion(s)

Intraoperative subjective overestimation of the true ovarian ischemia may lead to unnecessary oophorectomy. Per the American College of Obstetrics and Gynecology recommendation, patients with adnexal torsion should be treated surgically with ovarian conservation regardless of the appearance of the ovary. As demonstrated, ovaries reperfuse despite multiple twists along the infundibulopelvic pedicle, apparent necrosis, and large cysts. Unilateral salpingo-oophorectomies are avoidable even in these cases.

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