Use of Indocyanine Green to Detect Intraoperative Staple-Line Leaks in Robotic Bariatric Surgery: An Observational Cohort Study.

Background Bariatric surgeries aid weight loss in patients with morbid obesity, yet staple-line leaks pose safety concerns. Multiple methods are used to help identify these links. Intraluminal indocyanine green (ICG) has been shown to be useful in other applications, and its use in robotic bariatric surgeries is underexplored. Objective The primary objective of this research project was to demonstrate the usage of intraluminal ICG in detecting staple-line leaks during robotic sleeve gastrectomy and robotic gastric bypass. Settings The research was conducted at Bronxcare Health System between June 2022 and June 2023. Methods We studied 150 consecutive participants undergoing robotic sleeve gastrectomy or robotic gastric bypass. Intraluminal ICG was used in each case in order to identify leaks. Data on comorbidities, detected intraoperative leaks, and detected postoperative leaks were collected. Results Out of the 150 patients who underwent robotic bariatric surgeries (139 for sleeve gastrectomy and 11 for gastric bypass), four cases (two for each procedure) were identified with intraoperative leaks using ICG, resulting in an overall 2.66% incidence rate. In those four patients with intraoperative leaks, reinforcing sutures and a drain were placed. Following the surgeries, none of the patients had radiologic or clinical leaks identified. Conclusions Intraluminal ICG presents a novel approach for detecting staple-line leaks in robotic bariatric surgery. Future studies can be done to look at a larger series of patients and compare leak detection rates between ICG and other methods.

A Displaced Intrauterine Device Eroding Into the Sigmoid Colon.

A 36-year-old female presented to the gynecology office eight weeks after the placement of a ParaGard intrauterine device (IUD). Upon gynecologic examination, the strings of the IUD were not found. Magnetic resonance imaging was performed which reported the IUD embedded in the sigmoid colon. Initial diagnostic laparoscopy was done without bowel preparation and revealed an IUD embedded within the sigmoid colon and mesocolon. Colonoscopy did not reveal any breach of the colonic lumen. A second diagnostic laparoscopy was planned with the robotic-assisted technique after bowel preparation. Intraoperative findings during the second operation identified the IUD embedded in the antimesenteric side of the sigmoid colon with surrounding scar tissue to the uterus. The IUD was sharply freed using robotic scissors and the resulting serosal defect was sutured in layers with buttress made of appendices epiploica. The patient recovered well and had an excellent outcome. Our article highlights the minimally invasive method of dealing with a displaced IUD. The use of the robotic technique was helpful in our case to achieve an excellent outcome.