Design: Surgical video case study.

Setting: Academic medical center

Patients or Participants: A 34 year-old nulliparous women with a history of dysmenorrhea presented with imaging findings concerning for extensive pelvic endometriosis, including large left ovarian endometriomas and endometrial deposits in the cul-de-sac.

Interventions: At the onset the patient's surgery, a laparoscopic resection of endometriosis, ovarian cystectomy, and Mirena IUD placement, the patient underwent cystoscopy with insertion of bilateral open ended 5 French ureteral catheters to 10cm and injection of 5cc indocyanine green on each side. The catheters were then withdrawn and indocyanine green was visualized with near-infrared fluorescence (NIRF)-capable laparoscopic camera on overlay mode.

Measurements and Main Results: This video demonstrates how the use of ureteral ICG aids in ureteral identification during complex laparoscopic surgery, potentially preventing injury. During this case, the ureter may be visualized while dissection is occurring within the peritoneal cavity, as well as during retroperitoneal dissection and ureterolysis.

Conclusion: The use of ureteral indocyanine green is a practical technique that can serve as an adjunct in complex laparoscopic gynecologic surgery to aid in ureteral identification and avoidance of ureteral injury.