Intraureteric Indocyanine Green in Laparoscopic Endometriosis Surgery Ten Steps

OBJECTIVE: To demonstrate a step-by-step technique of intraoperative intraureteric indocyanine green (ICG) administration under cystoscopic guidance to localize intraoperative ureters under near-infrared fluorescence imaging during laparoscopic deep endometriosis surgery. The standardization and description of the surgery in 10 steps are the main objective of this video (Supplemental Video 1). SETTING: A university tertiary care hospital. PARTICIPANT: Patient who was diagnosed with deep endometriosis underwent laparoscopic surgery treatment. The local institutional review board ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case. INTERVENTION: Ten main steps of cystoscopy with intraureteral ICG administration to allow real-time visualization of intraoperative ureters during adhesiolysis and endometriosis resection were described in detail: Step 1: preparing ICG; step 2: preparing ureteric catheter; step 3: preparing instruments for cystoscopy; step 4: cystoscopy; step 5: identifying the ureteric orifices; step 6: inserting ureteric catheter through ureteric orifices; step 7: injecting ICG; step 8: laparoscopic surgery; step 9: intraoperative visualization of ureters; and step 10: deep endometriosis surgery. CONCLUSION: The use of cystoscopy-guided intraureteric ICG dye instillation and intraoperative ureteric near-infrared fluorescence imaging is a safe and effective tool for visualization of the ureteric position precisely and in real time, making the procedure faster and easier and reducing the intraoperative ureteric complication during laparoscopic deep endometriosis surgery [1-5]. VIDEO ABSTRACT.