Prognostication of Ovarian Function Following Ovarian Torsion Using Intraoperative Indocyanine Green Angiography

Keisuke Oyama, Kazunori Nakamoto, Makiko Omori, Hiroko Fukasawa, Shuji Hirata
Journal of Minimally Invasive Gynecology 2021 August 7

STUDY OBJECTIVE: To quantitatively evaluate the blood flow of ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess its use as an indicator for functional preservation of the ovaries.

DESIGN: In vivo animal study.

SETTING: The University of Yamanashi Animal Experimentation Center.

ANIMALS: Eighteen female Wistar albino rats.

INTERVENTIONS: Instead of torsion, after occluding one of the ovaries for 24 hours, we performed ICGA before and after releasing and extracted the following eight parameters: Fmax (maximum F value before releasing ischemia), Tmax (time taken from the onset of an increase in F to reaching Fmax ), T1/2max (time taken from the onset of an increase in F to reaching half of Fmax ), slope (Fmax /Tmax ), and time ratio (T1/2max /Tmax ), F'max (maximum F value after releasing ischemia), reperfusion rate (F'max /Fmax ) and reperfusion gap (F'max - Fmax ). Four weeks later, we counted the total number of primordial and primary follicles and classified the rats into functional and non-functional groups.

MEASUREMENTS AND MAIN RESULTS: Based on the total number of primordial and primary follicles, 13 rats had "functional" ovaries on the clamped side, and five rats had "non-functional" ovaries. The areas under the curve for each parameter were as follows: Fmax , 0.908; Tmax , 0.569; T1/2max , 0.546; time ratio, 0.746; slope, 0.877; F'max , 0.723; reperfusion rate, 0.938; and reperfusion gap, 0.862.

CONCLUSION: ICGA can be used to quantitatively evaluate ovaries that have been subjected to ischemia, and the magnitude of fluorescence intensity can be an excellent predictor of ovarian necrosis. Quantifying the degree of reperfusion immediately after the release of ischemia can be an equally excellent predictor of necrosis.

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