Design: We present a surgical video which demonstrates use of indocyanine green under near infrared fluorescence light while performing surgical excision of a deep infiltrating endometriosis lesion in close proximity to the ureter.

Setting: ICG technology has gained more use in complex colorectal and gynecological surgery overtime, specifically in patients with advanced endometriosis where dense adhesive disease poses an increased risk for ureteral injury^1,2.

Patients or Participants: Patients undergoing robot-assisted laparoscopic excision of endometriosis.

Interventions: Use of ICG firefly technology for identification of the ureter during ureterolysis for complex endometriosis resection.

Measurements and Main Results: Illustration of a safe, effective method of identifying the ureters during ureterolysis.

Conclusion: With increasing use of minimally invasive approaches to surgery, application of ICG fluorescence intraoperatively may offer improved visualization of the ureter and may help to mitigate the risk of iatrogenic ureteral injuries when performing ureterolysis to resect complex endometriosis lesions.

References:

1. Guan, X., Guan, Z., Sunkara, S., & Thigpen, B. (2023). Indocyanine Green-Assisted Retrograde Ureterolysis in Robotic Transvaginal NOTES for the Management of Stage IV Endometriosis with Obliterated Cul-de-sac. Journal of minimally invasive gynecology, 30(4), 266–267. https://doi.org/10.1016/j.jmig.2023.02.005

2. White, L.A., Joseph, J.P., Yang, D.Y., Kelley, S.R., Mathis, K.L., Behm, K. and Viers, B.R. (2021), Intraureteral indocyanine green augments ureteral identification and avoidance during complex robotic-assisted colorectal surgery. Colorectal Dis, 23: 718-723. https://doi.org/10.1111/codi.15407