CASE REPORT Overcoming the obstacles of visualization in robotically assisted abdominal cerclage using indocyanine green Burak Zeybek 1 • Mostafa Borahay 1 • Gokhan Sami Kilic 1 Received: 25 January 2016 / Accepted: 28 March 2016 Ó Springer-Verlag London 2016 Abstract Abdominal cerclage is found to have success rates of 85–95 % with lower incidence of preterm delivery and preterm premature rupture of membranes when com- pared to the vaginal approach. However, since it is more invasive, its use has been limited to selected cases. Robot- assisted abdominal cerclage is a relatively new minimally invasive technique that gives the opportunity for less invasive procedures when compared to the open technique and, when compared to conventional laparoscopy, has the advantages of 3D visualization and endowristed instru- mentation. The distinctive feature of our case is the use of near infrared camera system, which is a relatively new modality in robotics and, to the best of our knowledge, this is the first report in the literature that indocyanine green dye was used to help to visualize vascular anatomy during a robotic cerclage procedure in a pregnant patient. Keywords Robotics Á Cerclage Á Near infrared camera Á Indocyanine green Background Abdominal cerclage is found to have success rates of 85–95 % with lower incidence of preterm delivery and preterm premature rupture of membranes when compared to the vaginal approach [1]. However, since it is more invasive, its use has been limited to selected cases. The benefits of minimally invasive abdominal cerclage with conventional laparoscopy has already been shown in studies with comparable results and with well known advantages over traditional laparotomy such as shorter hospital stay, decreased blood loss and quicker recovery time [2, 3]. Robot-assisted abdominal cerclage is a rela- tively new minimally invasive technique that gives the opportunity for less invasive procedures when compared to the open techniques and, when compared to laparoscopy, has the advantages of 3D visualization and endowristed instrumentation. Since the da Vinci surgical system (Intu- itive Surgical, Sunnyvale, CA) was approved by the US Food and Drug Administration (FDA) for gynecologic procedures, there have been only approximately 40 cases in the literature with the very first case reported in 2007 [4]. The distinctive feature of our case is the use of near infrared camera system, which is a relatively new modality in robotics and, to the best of our knowledge, this is the first report in the literature that indocyanine green (ICG) dye was used to help to visualize vascular anatomy during a robotic cerclage procedure in a pregnant patient. Case A 35-year-old woman gravida 3 para 1 at 13 weeks ges- tation was referred to our department due to a history of an IUFD at 22 weeks followed by a dilatation & evacuation (D&E). Her second pregnancy was complicated by preg- nancy loss at 19 weeks due to painless cervical dilation. The patient was not a good candidate for cervical cerclage because of a cervical laceration during the previous D&E. On presentation her dating criteria was confirmed by transvaginal ultrasound with a cervical length of 1.2 cm. First trimester fetal aneupleuidy screening was negative. & Burak Zeybek buzeybek@utmb.edu; bzeybek@yahoo.com 1 Department of Obstetrics and Gynecology, The University Of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA 123 J Robotic Surg DOI 10.1007/s11701-016-0585-9