Prevention of Ureteric Injuries in Total Laparoscopic Hysterectomy: Use of Indocyanine Green

The integration of laparoscopy into gynecological surgery has paved the way for innovative advancements in the field. As the complexity of laparoscopic approaches to gynaecological cases continues to increase, the incidence of ureteric injuries has also been observed in many cases. Hence, it is crucial for surgeons to be aware of the anatomy and potential sites of ureteral injury. The lower one-third of the ureter is most prone to injury. Some of the risk factors include an enlarged uterus, endometriosis, large ovarian mass, PID, previous pelvic surgery, cervical and broad ligament fibroid, a past history of pelvic radiation, and malignancies. In such cases, preoperative imaging of the kidney as part of pelvic sonography is recommended. Intraoperatively, we can use either illuminated stents or ICG. The ICG technique allows for easier identification of ureters using retrograde injection in the ureteral catheter while being visualized under NIRF imaging system in both robotic and laparoscopic surgeries. Therefore, by utilizing this advanced imaging system for precise visualization of the retroperitoneal ureter, iatrogenic ureteral damage can be avoided. This contributes to safer surgical procedures, potentially reducing the learning curve for beginners through guided ureteral navigation.