Observational studyScientific reports2025
Fluorescence-guided ureteral identification in robotic surgery for advanced endometriosis: a comparison of junior versus senior surgeons.
Observational study in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Indocyanine green for intraoperative ureteral identification in gynecologic surgery: A preliminary systematic review of feasibility, safety, and surgical outcomes.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Pooled it
- Successful Robot-Assisted Resection of a Retroperitoneal Cystic Tumor With Fluorescent Ureteral Stent and Firefly Imaging.IJU case reports · 2026Article
- Comparative outcomes of robotic single-port vNOTES versus robotic-Xi assisted single-incision transumbilical surgery for hysterectomy.Frontiers in surgery · 2026Article
- Stage-Specific outcomes of robotic transvaginal NOTES hysterectomy in endometriosis: A comparative study.Journal of robotic surgery · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Identifying the ureters in patients with advanced endometriosis and severe pelvic adhesive disease can be challenging. Adhesiolysis along the deformed pelvic sidewall may increase the risk of prolonged operative time and incidental ureteral injury. This study aimed to evaluate the safety and surgical outcomes of using Indocyanine Green (ICG) under near-infrared fluorescence for intraoperative ureteral localization and preservation during robot-assisted laparoscopic surgery (RALS) for advanced endometriosis, comparing procedures performed by two junior surgeons to those performed by one senior surgeon. This was a retrospective observational case series conducted by three minimally invasive gynecologic surgeons (X.G., T.K., B.T.) at a single tertiary care center between August 2021 and January 2025. A total of 92 patients underwent RALS using ICG fluorescence; 44 surgeries were performed by two junior surgeons, and 48 by a senior surgeon. The senior group had a higher percentage of patients with complete cul-de-sac obliteration (56.3% vs. 18.2%, p = 0.001). Our primary surgical outcome, total operative time, was 233 min in the junior group and 348 min in the senior group, initially showing a significant difference. However, after adjusting for factors such as history of prior abdominal surgery, cul-de-sac obliteration, and additional procedures (resection of ovarian remnant, bowel shaving, oophorectomy, enterolysis) using multivariable linear regression analysis, no significant difference was observed between the two groups. Other perioperative outcomes-including patient characteristics, estimated blood loss, length of hospital stay, and postoperative pain at weeks 1, 2, and 3-were comparable between the groups. Complication rates did not differ significantly. Notably, there were no cases of temporary or permanent ureteral injury in either group. These findings suggest that with ICG-assisted ureteral mapping, junior surgeons can achieve comparable surgical outcomes to senior surgeons. ICG facilitates intraoperative ureter identification, with the potential to enhance surgical safety by improving surgical precision and supporting the training of junior surgeons in managing complex endometriosis.
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