This video demonstrates Total Laparoscopic Hysterectomy with infrared fluorescence imaging of Ureter and Uterine artery with ICG at World Laparoscopy Hospital by Dr. R.K. Mishra. Injecting indocyanine green (ICG) enables the operators to identify the ureter and the uterine artery to perform a safe laparoscopic hysterectomy. A cyanine vital dye indocyanine green (ICG) is a safe NIR fluorophore emitting 800~840 nm of light and has been used in numerous surgical procedures. It also allows them to decide on the extent of the dissection and validate the completeness of the dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. According to the increasing needs and interest in precision surgery, which is characterized by individual tailored surgical strategies, image-guided surgery is receiving increased attention as the most intuitive and strong methodology to implement precision surgery.
Total Laparoscopic Hysterectomy + BSO Using Fluorescence Imaging of Ureter and Uterine Artery by Dr. R. K. Mishra at World Laparoscopy Hospital
Modern gynecological surgery has significantly evolved with the advancement of minimally invasive techniques. One of the most effective procedures for treating various uterine and ovarian diseases is Total Laparoscopic Hysterectomy (TLH) with Bilateral Salpingo-Oophorectomy (BSO). At World Laparoscopy Hospital, this procedure has been further enhanced using fluorescence imaging technology, performed by renowned laparoscopic surgeon Dr. R. K. Mishra. This innovative approach improves surgical safety, accuracy, and patient outcomes.
Total Laparoscopic Hysterectomy involves the complete removal of the uterus using minimally invasive laparoscopic instruments inserted through small abdominal incisions. When combined with Bilateral Salpingo-Oophorectomy, the procedure also includes the removal of both fallopian tubes and ovaries. This surgery is commonly performed for conditions such as uterine fibroids, abnormal uterine bleeding, endometriosis, adenomyosis, and certain gynecological cancers when conservative treatments are ineffective.
A major challenge during hysterectomy is the safe identification of critical anatomical structures such as the ureter and the uterine artery. Injury to the ureter is a known complication in pelvic surgery because of its close proximity to the uterus and uterine vessels. To overcome this challenge, Dr. Mishra utilizes near-infrared fluorescence imaging with Indocyanine Green (ICG). After injecting the fluorescent dye, special laparoscopic cameras detect the fluorescence emitted by the dye, clearly highlighting the ureter and uterine artery during surgery.
Indocyanine Green is a safe fluorescent dye that emits light in the 800–840 nm near-infrared spectrum, allowing surgeons to visualize vital structures in real time. With this technology, the ureter becomes clearly visible, enabling surgeons to avoid accidental injury. Similarly, the uterine artery can be accurately identified and safely controlled during the procedure. This enhanced visualization helps surgeons determine the exact extent of dissection and confirms the completeness of the surgical procedure.
The surgical procedure typically begins with the creation of pneumoperitoneum and the insertion of laparoscopic ports. The pelvic anatomy is carefully examined, and the ovaries and fallopian tubes are identified. Using advanced laparoscopic instruments and energy devices, the surgeon dissects the surrounding tissues while preserving important structures. Fluorescence imaging is then activated, allowing the surgeon to visualize the ureter and uterine artery clearly. Once these structures are identified, the uterine artery is safely sealed and divided, followed by the removal of the uterus, fallopian tubes, and ovaries through a minimally invasive approach.
This advanced technique offers several advantages for patients. Because the surgery is performed laparoscopically, it involves smaller incisions, reduced blood loss, less postoperative pain, shorter hospital stay, and faster recovery compared to traditional open surgery. Additionally, fluorescence imaging significantly reduces the risk of ureteric injury and improves surgical precision. The ability to visualize anatomical structures in real time enhances safety and contributes to better surgical outcomes.
Dr. R. K. Mishra is globally recognized for his contributions to minimal access surgery and surgical education. As the director of World Laparoscopy Hospital, he has trained thousands of surgeons from over 100 countries in laparoscopic and robotic surgery. The hospital is a leading international center for training, research, and advanced minimally invasive surgical procedures, promoting innovation and excellence in surgical practice.
In conclusion, Total Laparoscopic Hysterectomy with BSO using fluorescence imaging represents a significant advancement in modern gynecological surgery. The integration of near-infrared imaging with laparoscopic techniques allows surgeons to operate with greater precision and safety. Under the expertise of Dr. R. K. Mishra at World Laparoscopy Hospital, this technique demonstrates how technological innovation can improve surgical outcomes while maintaining the core principles of minimally invasive surgery. It stands as a remarkable example of how image-guided surgery is shaping the future of precision gynecology.
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