Discover the use of fluorescence imaging in reproductive surgery through this educational demonstration of ICG-guided laparoscopic chromopertubation at World Laparoscopy Hospital. This procedure focuses on evaluating fallopian tube patency using indocyanine green (ICG) dye and a compatible near-infrared laparoscopic imaging system.

Fallopian tube assessment is an important part of infertility evaluation. Even when the uterus and ovaries appear normal, tubal blockage or damage may prevent the egg and sperm from meeting. Chromopertubation allows the surgeon to observe dye passage through the fallopian tubes during laparoscopy, providing useful information about their openness.

ICG fluorescence adds another imaging approach to this procedure. Instead of relying only on the visible colour of conventional dyes, the surgeon can use near-infrared imaging to observe the fluorescent signal as the dye moves through the reproductive tract.

Why Is Tubal Patency Assessment Important?

The fallopian tubes play an essential role in natural conception. They provide the pathway through which the egg travels and where fertilization commonly occurs. Their inner lining and muscular activity also contribute to the transport of the early embryo towards the uterus.

Tubal disease may develop due to pelvic infection, endometriosis, previous ectopic pregnancy, adhesions, or previous pelvic surgery. In some women, tubal damage does not produce noticeable symptoms.

Common reasons for evaluating tubal patency include:

• Primary or secondary infertility.

• A history of pelvic inflammatory disease.

• Previous ectopic pregnancy.

• Suspected endometriosis or pelvic adhesions.

• Previous pelvic or tubal surgery.

• Suspected hydrosalpinx or tubal obstruction.

• Assessment during planned laparoscopic reproductive surgery.

The findings help the treating specialist understand whether the fallopian tubes appear open and whether additional investigation or treatment may be appropriate.

Conventional Chromopertubation and ICG Fluorescence

Conventional laparoscopic chromopertubation generally involves introducing a coloured dye, commonly methylene blue or indigo carmine, through the cervix. The surgeon observes the fallopian tubes and looks for dye emerging from their fimbrial ends.

ICG offers a different visualization method. It is a fluorescent dye that emits a detectable signal when illuminated by an appropriate near-infrared imaging system. When administered through the uterine cavity, its passage can be assessed using compatible laparoscopic fluorescence technology.

Potential educational advantages of ICG-based visualization include:

• Real-time fluorescence-based observation.

• Additional visualization of dye passage.

• Less visible staining of surrounding tissues under ordinary white-light imaging.

• Integration with compatible laparoscopic or robotic imaging platforms.

• An additional option for intraoperative tubal assessment.

ICG-guided chromopertubation is an emerging application, and its clinical evidence and protocols are still developing. It should not be described as universally superior to conventional dye testing.

Step-by-Step Surgical Technique

1. Preoperative Assessment

The patient is evaluated according to her reproductive history, infertility duration, previous pregnancies, pelvic infections, surgical history, and other relevant clinical findings.

The surgeon reviews available investigations and determines whether laparoscopic assessment is appropriate. Less invasive tests, such as hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy), may be considered as part of the initial infertility evaluation.

2. Anesthesia and Patient Positioning

The procedure is performed under appropriate anesthesia. The patient is positioned to facilitate abdominal laparoscopic access and transcervical dye administration. Standard monitoring and surgical preparation are completed.

3. Establishing Laparoscopic Access

Pneumoperitoneum is created using an appropriate technique, and laparoscopic ports are placed. The surgeon introduces the camera and inspects the pelvis.

Both fallopian tubes, ovaries, uterus, pelvic sidewalls, and surrounding structures are assessed. The surgeon looks for adhesions, endometriosis, hydrosalpinx, and other abnormalities that may influence tubal function.

4. Placement of the Uterine Cannula

A suitable uterine cannula or manipulator is positioned through the cervix. It provides access for introducing the prepared dye into the uterine cavity.

The team confirms appropriate positioning and checks the equipment before dye administration.

5. Preparation and Administration of ICG

ICG is prepared according to the selected institutional protocol and the product instructions. The dye is introduced through the cervical cannula into the uterine cavity under controlled conditions.

The concentration, dilution, and volume must be determined by the clinical team according to the intended application and equipment. A standardized protocol is important for obtaining interpretable fluorescence images.

6. Activation of Near-Infrared Fluorescence Imaging

The laparoscopic imaging system is switched to the appropriate fluorescence mode. The surgeon observes the fluorescent signal as the dye moves from the uterine cavity into the fallopian tubes.

A compatible near-infrared system is essential because ordinary white-light imaging alone cannot display the same fluorescence information.

7. Assessment of Tubal Passage

The surgeon evaluates each fallopian tube separately and looks for the passage of fluorescent dye towards the fimbrial end. Visible distal spill into the peritoneal cavity supports tubal patency at the time of testing.

The findings may demonstrate bilateral passage, unilateral passage, or suspected obstruction. If fluorescence is not seen, the surgeon considers possible technical factors, tubal spasm, cannula positioning, and other causes before interpreting the result.

8. Assessment of Pelvic Pathology

Laparoscopy also provides direct visualization of the external appearance of the tubes and surrounding pelvic structures. The surgeon may identify adhesions, endometriosis, fimbrial abnormalities, or hydrosalpinx.

These findings are clinically important because an apparently patent tube may still have impaired function due to structural damage or disease.

9. Documentation and Completion

The observations are documented, including the fluorescence findings for each tube and any additional pelvic abnormalities. The procedure is completed according to the operative plan, followed by routine postoperative monitoring.

Interpreting the Findings Correctly

A positive dye spill indicates that a pathway for fluid passage was present during the procedure. However, it does not prove that the tube is fully functional for natural conception.

Tubal function also depends on the condition of the tubal lining, ciliary activity, muscular movement, and the relationship between the fimbriae and ovary.

Similarly, the absence of visible dye passage does not automatically establish permanent blockage. Possible explanations include:

• Transient tubal spasm.

• Incorrect cannula positioning.

• Inadequate dye delivery or pressure.

• Technical limitations of the imaging system.

• True proximal or distal tubal obstruction.

The surgeon should interpret fluorescence findings alongside the laparoscopic appearance, clinical history, and other investigations.

Safety and Clinical Considerations

ICG is generally used with established precautions, but clinicians must review the patient's allergy history, relevant contraindications, and product-specific safety information before administration. Appropriate preparation and dosing are important.

Laparoscopy itself carries risks associated with anesthesia, abdominal access, bleeding, infection, and injury to surrounding structures. Chromopertubation also requires controlled dye administration and appropriate interpretation of the findings.

It is important to remember that diagnostic laparoscopy is not recommended as a routine first-line test for every woman undergoing infertility evaluation. Less invasive investigations are generally considered first, with laparoscopy reserved for selected clinical situations or when another surgical indication exists.

The Role of Fluorescence Imaging in Modern Gynecology

ICG fluorescence has applications across several areas of minimally invasive gynecological surgery, including visualization of selected anatomical structures, assessment of tissue perfusion, and other procedure-specific applications.

In tubal patency assessment, ICG provides an additional method of observing dye movement under near-infrared imaging. It is a promising development in reproductive surgery, but further research is needed to establish standardized protocols and determine its comparative diagnostic performance.

Advanced Surgical Learning at World Laparoscopy Hospital

World Laparoscopy Hospital provides educational opportunities for gynecologists, laparoscopic surgeons, and medical professionals interested in advanced minimally invasive surgery.

This demonstration highlights the integration of reproductive anatomy, laparoscopic visualization, fluorescence technology, and clinical interpretation. It can help trainees understand how tubal patency is assessed and why the findings must be evaluated in the context of the patient's overall fertility profile.

Watch the complete surgical video to explore ICG fluorescence-guided laparoscopic chromopertubation and learn about the role of near-infrared imaging in the assessment of fallopian tube patency.

Educational disclaimer: This content is intended for medical education and professional training. The choice of dye, imaging method, and diagnostic approach must be determined by qualified clinicians according to the patient's condition and the applicable clinical protocol.