Design: Retrospective analysis of the safety & efficacy of cystoscopic instillation of ICG dye for intraoperative visualisation of ureters during
laparoscopic myomectomy for large fibroids.

Setting: Tertiary care referral centre for MIGS equipped with advanced laparoscopic instrumentation including the 4K/ 3D Camera System with ICG/NIR Overlay feature.

Patients or Participants: The indexed case involves a 31-year-old unmarried lady with complaints of heaviness in her lower abdomen for 2-3 months. Her per abdominal examination revealed a uterine mass of pelvic origin of around 30 weeks insize, it was firm and had limited mobility. Her MRI scan revealed a normal-sized uterus with a posterior 24 cm x 20 cm x 9.6 cm T2 hyper-intense lesion causing mass effects on the uterine body, bladder, anorectal area, bowel loops and ureters. She was eventually planned for laparoscopic myomectomy.

Interventions: The primary intervention was the administration of ICG dye via cystoscopy into the ureters before the laparoscopic myomectomy procedure allowing real-time visualisation of the ureters' course and integrity during the surgery. Initial mechanical un-contained followed by contained in bag morcellation of the large specimen was done after confirming the mass as benign on frozen section.

Measurements and Main Results: Our study found that using ICG dye via cystoscopy during laparoscopic myomectomy effectively enhanced ureteral visualisation, leading to reduced risk of injury and high surgical success rates. This technique offers promise for improving safety and precision in such complex procedures
 

Conclusion: Our study demonstrates the utility of ICG dye via cystoscopy for intra-operative visualisation of the ureters during laparoscopic myomectomy which significantly enhances surgical safety by facilitating real-time identification of the ureter's course and integrity, thereby reducing the risk of ureteral injury
and improving overall surgical success rates.