Identification of Ureters with ICG Dye in Endometriosis and Benign Gynaecology

Abstract

Study Objective The purpose of this video is to demonstrate the use of ICG dye to identify and facilitate dissection of ureters in endometriosis and other benign cases. Design Technical video demonstrating the laparoscopic identification of ureters with ICG dye (Canadian Task Force classification level III). Setting Minimally Invasive Surgery Gynaecology Unit, Liverpool Hospital. Patients or Participants 3 cases demonstrated. Interventions Indocyanine green (ICG) is a fluorescent dye that, when activated with a specific wavelength of near-infrared (NIR) light, permits the exact measurement of tissue vascularization in real time during surgery. The ICG irreversibly stains the lining of the ureter by binding to the proteins on the urothelial layer. The infrared signals are then captured by the console and electronically converts into green color which then facilitates easy identification of bilateral ureters thus reducing the risk of injury. This video presents one of its uses in benign gynaecology. Measurements and Main Results Thus, this is a technology allowing to intraoperatively enhance the visualization of the ureters, potentially reducing the risks and/or favoring an immediate identification of injuries, and will have a relevant clinical impact Conclusion We discovered that ICG is a useful method for identifying ureters in challenging situations, particularly those with retroperitoneal fibrosis. The purpose of this video is to demonstrate the use of ICG dye to identify and facilitate dissection of ureters in endometriosis and other benign cases. Technical video demonstrating the laparoscopic identification of ureters with ICG dye (Canadian Task Force classification level III). Minimally Invasive Surgery Gynaecology Unit, Liverpool Hospital. 3 cases demonstrated. Indocyanine green (ICG) is a fluorescent dye that, when activated with a specific wavelength of near-infrared (NIR) light, permits the exact measurement of tissue vascularization in real time during surgery. The ICG irreversibly stains the lining of the ureter by binding to the proteins on the urothelial layer. The infrared signals are then captured by the console and electronically converts into green color which then facilitates easy identification of bilateral ureters thus reducing the risk of injury. This video presents one of its uses in benign gynaecology. Thus, this is a technology allowing to intraoperatively enhance the visualization of the ureters, potentially reducing the risks and/or favoring an immediate identification of injuries, and will have a relevant clinical impact We discovered that ICG is a useful method for identifying ureters in challenging situations, particularly those with retroperitoneal fibrosis.