Intra-Ureteral Indocyanine Green (ICG) Dye Use During Complex Pelvic Surgery: A Surgical Tutorial and Guide

Abstract

Study Objective

This surgical tutorial demonstrates an efficient and reproducible technique for use of intra-ureteral indocyanine green (ICG) dye at the time of ureteral catheter placement to aid in intraoperative ureteral visualization.

Design

Narrated instructional surgical video.

Setting

Academic tertiary care hospital.

Patients or Participants

Two patients undergoing complex robotic gynecologic surgery with anticipated severe pelvic anatomic distortion or adhesive disease.

Interventions

Stepwise demonstration of surgical technique and considerations during ureteral catheter placement with injection of ICG dye at the time of complex pelvic surgery.

Measurements and Main Results

This video describes 1) operative set-up, 2) surgical techniques and considerations during ureteral catheter placement and intra-ureteral ICG dye injection, and 3) demonstration of near infra-red (NIR) visualization of ICG dye intraoperatively.

Conclusion

Although the overall risk of lower urinary tract injury during pelvic surgery is low, complex gynecologic surgery with distorted pelvic anatomy or significant adhesive disease poses an increased risk for ureteral obscurement and injury. Use of intra-ureteral ICG dye is a safe and replicable method of ureteral visualization with the potential to improve the safety of complex minimally invasive pelvic surgery. This instructional video tutorial provides surgeons with a reproducible technique for intra-ureteral ICG dye use at the time of pelvic surgery.