Research Information System
Journal of Minimally Invasive Gynecology, 2026 (SCI-Expanded, Scopus)
Objective: To demonstrate the advantages of combining robotic-assisted surgery with Indocyanine Green (ICG) fluorescence imaging in the excision of pelvic retroperitoneal schwannomas, with a particular focus on nerve preservation. Setting: Gynecologic unit of a tertiary center. Participants: A 47-year-old female presented with severe pelvic pain, characterized as intermittent throughout the day and not exacerbated by positional changes or activity, with no additional complaints other than occasional urinary frequency.Magnetic resonance imaging revealed a 5 cm schwannoma located adjacent to the right internal iliac vein and the right hypogastric nerve. Interventions: A stepwise narrated video demonstrates the technique using a combined robotic-assisted surgical approach was employed, enhanced by intravenous administration of 6mg ICG at the initiation of retroperitoneal dissection. Real-time ICG fluorescence enabled clear demarcation of the hypervascular schwannoma [1], distinctly contrasting with the non-fluorescent right hypogastric nerve. This contrast facilitated atraumatic nerve lateralization [2],preserving autonomic function and enabling high surgical precision. A focal area of intense fluorescence within the tumor suggested uncapsulated tissue, prompting meticulous inspection of the excision bed, where residual capsular tissue was identified and fully excised from the deep presacral space without vascular injury. The use of robotic instrumentation allowed safe dissection near dense vascular and neural plexuses [3], particularly the internal iliac vein. The specimen and excised residual capsule were extracted transvaginally via posterior colpotomy using an endoscopic retrieval bag, minimizing abdominal trauma and preventing oncologic spillage. Conclusion: The combined use of robotic-assisted surgery and ICG significantly enhances intraoperative visualization, facilitates precise dissection within complex pelvic anatomy, and supports critical nerve preservation during pelvic schwannoma resection. This approach minimizes vascular injury, reduces blood loss, and enables complete tumor excision, including residual capsular tissue, without increasing surgical morbidity and faster recovery. As the first reported case of its kind, this technique demonstrates substantial clinical efficacy and offers valuable guidance for advanced gynecologic surgical practice.