Ureteral injury is a rare but serious complication in gynecological surgeries, particularly during laparoscopic procedures involving the pelvic organs. Early identification and protection of the ureters are critical to prevent morbidity such as urinary leakage, fistula formation, and renal impairment.

Infrared ureteral stenting is an innovative technique that enhances the visualization and safety of ureters during minimally invasive gynecologic surgeries. By using infrared or near-infrared imaging, surgeons can accurately identify ureteral anatomy, reduce the risk of injury, and facilitate safer dissection during procedures like hysterectomy, myomectomy, or endometriosis surgery.

Dr. R. K. Mishra, a pioneer in advanced laparoscopic gynecologic surgery, has demonstrated the use of infrared ureteral stents to improve surgical safety and outcomes in complex pelvic procedures.

Indications

Infrared ureteral stenting is particularly indicated in:

Complex gynecological laparoscopic procedures with high risk of ureteral injury, such as:

Total laparoscopic hysterectomy (TLH)

Myomectomy for large or posterior fibroids

Endometriosis surgery involving deep pelvic dissections

Previous pelvic surgeries or adhesions where ureteral anatomy may be distorted

Malignancy surgeries requiring extensive dissection near the ureters

Patients with congenital anomalies or prior radiation therapy affecting pelvic structures

Preoperative Preparation

Patient Assessment:

Evaluate history of previous surgeries, urinary tract abnormalities, or pelvic infections

Imaging with ultrasound, CT, or MRI may help delineate ureteral course in complex cases

Consent and Counseling:

Explain the procedure, benefits of ureteral stenting, and potential complications

Discuss anesthesia and postoperative care

Anesthesia:

General anesthesia is preferred for laparoscopic gynecologic procedures

Ensure adequate relaxation for optimal pelvic access

Surgical Technique
Cystoscopic Stent Placement

The ureteral stent, equipped with an infrared marker, is introduced cystoscopically into the ureter before starting laparoscopy.

Proper placement ensures the stent is well-positioned from the renal pelvis to the bladder, allowing continuous ureteral identification during surgery.

Laparoscopic Visualization

Using a laparoscope equipped with an infrared or near-infrared camera system, the ureters are visualized as glowing structures within the pelvis.

The stents emit infrared light that is easily distinguishable from surrounding tissues, helping the surgeon identify the course, proximity to vessels, and relationship to surgical planes.

Dissection and Surgery

During procedures such as hysterectomy, myomectomy, or excision of endometriotic lesions, the ureter can be safely dissected away from operative areas.

Infrared guidance allows real-time identification of ureters, minimizing the risk of accidental injury.

Postoperative Stent Management

The ureteral stent may be left in place temporarily for high-risk cases to prevent ureteral obstruction or injury.

Typically, stents are removed within 1–2 weeks postoperatively after confirming ureteral integrity.

Advantages of Infrared Ureteral Stenting

Enhanced Safety: Accurate ureteral identification significantly reduces the risk of injury.

Real-Time Guidance: Surgeons can visualize ureters throughout the dissection.

Minimally Invasive: Avoids the need for open ureteral exposure or complex intraoperative maneuvers.

Time-Saving: Faster identification reduces operative time and allows more precise surgery.

Educational Value: Trainees can clearly appreciate ureteral anatomy and surgical planes under infrared guidance.

Dr. R. K. Mishra emphasizes that infrared stenting should be considered in all high-risk laparoscopic cases to optimize patient safety.

Challenges and Considerations

Requires specialized infrared-compatible stents and laparoscopic cameras.

Proper placement of stents is essential; malposition can lead to false security or ureteral injury.

Surgeons must be trained in both cystoscopy and laparoscopic infrared visualization.

Careful fluid management and gentle tissue handling are necessary to maintain visibility.

Clinical Outcomes

Studies and clinical experience demonstrate:

Significant reduction in ureteral injury rates during complex gynecologic laparoscopy

Shorter operative times due to rapid identification of ureters

Favorable patient outcomes, with reduced postoperative complications and faster recovery

Improved confidence and precision for surgeons during difficult pelvic dissections

Conclusion

Infrared ureteral stenting represents a major advancement in gynecologic laparoscopy, enhancing ureteral safety, reducing complications, and improving surgical precision.

By combining real-time infrared visualization with minimally invasive techniques, surgeons can perform complex procedures like hysterectomy, myomectomy, and endometriosis excision with confidence and safety.

Dr. R. K. Mishra’s use of this technique demonstrates the future of advanced laparoscopic gynecologic surgery, where innovation, precision, and patient safety converge to provide optimal outcomes.