Study Objective: Ever since Scali et al. described a procedural modification of sacrocolpopexy (SCP) involving the dissection of the vesicovaginal space to improve the cure rate for cystocele in 1974 the question remains as to the ideal location for dissection during a SCP. Instruments are occasionally placed at the lowest point of prolapse vaginally and tactile feedback is used to assess when that point is reached abdominally. However, this not only makes vaginal manipulation harder, but also the absence of true tactile feedback in the ever-advancing robotic space makes this more difficult to accomplish. At Sydney Womens Endosurgery Centre we set out to find a simpler and more effective way of determining optimal dissection using indocyanine green (ICG), which is a fluorescent compound that has been used in medicine for more than 60 years

Design: N/A

Setting: N/A

Patients or Participants: This procedure was carried out on a 58-year-old woman for laparoscopic hysterectomy, sacrocolpopexy and burch colposuspension for stage-3 vault prolapse with urodynamic confirmed stress incontinence.

Interventions: The two clamps that are usually used at the lowest point of prolapse were replaced with injection of ICG diluted in sterile water directly into the vaginal tissue at the appropriate location on both the anterior and posterior vagina. As can be visualised in the video fluorescence with the Stryker AIM system clearly highlights when that point had been reached on both the posterior and anterior vaginal wall. No tactile feedback was necessary. The remainder of the surgery was completed and the patient made an unremarkable recovery.

Measurements and Main Results: N/A

Conclusion: The use of ICG during sacrocolpopexy is a new novel surgical technique that can be used to identify the ideal site of dissection whilst also simplifying the second assistants task and reducing the need for tactile feedback surgically. This technique is currently being validated via a prospective trial and long-term follow-up