Title : The role of indocyanine green in minimizing ureteral injuries in complex total laparoscopic hysterectomy
Abstract:
Total Laparoscopic Hysterectomy (TLH) carries a significant riks (1.2%, range 0.6%–4%) of ureteral complications, higher than open abdominal or vaginal approach.
The presence of large fibroids leads to poor pelvic visibility, decreased uterine mobility, deformity and displacement of the ureters from their anatomical positions
This is a case of a 49 years old women with no previous major abdominal surgeries suffering from menometrorrhagia. The uterus measured 14 cm of lenght and showed a diffuse fibromatosis, where the largest were a posterior 8 cm FIGO 7 fibroid and a right 6 cm infraligamentous FIGO 6 fibroid. TLH with bilateral salpingoophorectomy was recommended
Immediately before surgery, cystoscopy was performed, and retrograde instillation of 25 milligrams of ICG dissolved in 10-mL of sterile water was performed into both ureters via a ureteric catheter.
The dye was tracked intraoperatively in real-time using an infrared fluorescence system.
Using this property of ICG, ureters were visualized from inside the embedded surrounding tissues during laparoscopic surgeries preventing iatrogenic ureteral injuries.
