title: Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy.
abstract: OBJECTIVE
  The aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy.
  
  
  METHODS
  Data were collected from all patients diagnosed with early-stage cervical cancer that underwent laser angiography with ICG during open or laparoscopic radical trachelectomy from June 2012 to December 2015. Regression analysis was use to determine the p values and R-squares on fluorescence, surgical time, hospital stay, age and BMI; a p-value<0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 20 patients met the inclusion criteria and were included in this study. Ten patients underwent uterine artery-sparing surgery, and ten patients underwent uterine artery non-sparing surgery. The most frequent stage for the entire cohort was IA2 (55%), and the most common histologic subtype was squamous cell carcinoma (49%). Lymph-vascular invasion was noted in 30% of the patients. There was no statistical significance difference in the mean ICG fundal fluorescence intensity between the uterine artery-sparing group 162.5 (range, 137-188) and the uterine artery non-sparing group 160.5 (range, 135-186), p=0.22. In both groups, 100% of the patients regained their menstrual function by postoperative week 8. A total of 4 (40%) pregnancies have occurred in the uterine artery-sparing group and 3 (30%) in the non-uterine artery-sparing group.
  
  
  CONCLUSIONS
  Based on our real-time intraoperative angiography observations, there is no need to preserve the uterine artery during radical trachelectomy to maintain uterine viability.
authors.affiliation: Department of Gynecologic Oncology & Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, United States; Instituto Gyneco-Oncólogico, San Juan 00926, Puerto Rico. Electronic address: escobarp@mac.com.
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Escobar
authors.affiliation: Department of Gynecologic Oncology & Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, United States.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Obstetrics and Gynecology, Hospital San Lucas, Ponce, Puerto Rico.
authors.forename: Rafael E
authors.initials: RE
authors.lastname: Garcia Ocasio
authors.affiliation: Gynecologic Oncology Unit, Instituto de Cancerologia Las Americas, Medellin, Colombia.
authors.forename: Rene
authors.initials: R
authors.lastname: Pareja
authors.affiliation: Department of Gynecology, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Steve
authors.initials: S
authors.lastname: Zimberg
authors.affiliation: Department of Gynecology, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Sprague
authors.affiliation: Department of Gynecologic Oncology & Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
mesh_terms: D000328:Adult; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D000069339:Trachelectomy; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D014599:Uterus / Q000098:blood supply*
chemical_list: D007208:Indocyanine Green
keywords: Angiography; Cervical cancer; Fertility-sparing; ICG; Laparoscopy; Trachelectomy