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 (TLH) with Bilateral Salpingo-Oophorectomy (BSO) represents a major advancement in minimally invasive gynecological surgery. The integration of fluorescence imaging for visualization of the ureter and uterine artery has further enhanced surgical precision and safety. At World Laparoscopy Hospital, this advanced technique is performed using modern image-guided surgical systems, combining laparoscopic skill with real-time anatomical mapping.

TLH involves complete laparoscopic removal of the uterus, while BSO includes removal of both fallopian tubes and ovaries. Compared to open surgery, this approach provides benefits such as reduced postoperative pain, shorter hospital stay, minimal blood loss, and faster recovery. However, challenges remain, especially related to ureteric and vascular injury risk. The introduction of fluorescence imaging using indocyanine green (ICG) has significantly improved the surgeon’s ability to identify vital structures during surgery.

Fluorescence imaging works by injecting indocyanine green dye, which fluoresces under near-infrared light. When viewed through a special laparoscopic camera, the dye highlights structures like the ureter and uterine artery in real time. ICG is a safe near-infrared fluorophore that emits light at approximately 800–840 nm and has been widely used in various surgical specialties. This technique allows surgeons to determine the exact extent of dissection and confirm completeness of tissue removal, supporting precision surgery and individualized operative strategies.

Visualization of the ureter is particularly important because ureteric injury is one of the most serious complications during hysterectomy. Near-infrared fluorescence allows clear identification of the ureter even when normal anatomical landmarks are distorted by adhesions, fibroids, or previous surgery. Real-time fluorescence mapping improves surgical confidence and helps reduce accidental damage to the ureter. Studies suggest that ICG-based ureteral mapping can complement surgical technique and potentially reduce iatrogenic ureteral injury, although more large-scale studies are still needed.

Similarly, fluorescence imaging of the uterine artery helps surgeons achieve precise vascular control. ICG provides real-time blood flow mapping, allowing accurate coagulation and reducing intraoperative bleeding. This improves hemostasis and supports safe dissection of surrounding tissues. In complex cases, fluorescence imaging helps surgeons make better intraoperative decisions, especially when anatomy is unclear or distorted.

At World Laparoscopy Hospital, the use of fluorescence imaging reflects the global shift toward image-guided and precision surgery. Modern laparoscopic near-infrared camera systems provide multiple visualization modes, allowing surgeons to switch between normal and fluorescence views seamlessly. This technology represents the future of minimally invasive gynecology by combining surgical expertise with advanced optical imaging.

In conclusion, Total Laparoscopic Hysterectomy with BSO using fluorescence imaging of the ureter and uterine artery is a highly advanced, safe, and effective surgical technique. The use of ICG fluorescence improves visualization, reduces complication risk, and enhances surgical accuracy. With increasing adoption of image-guided surgery and continuous technological advancements, this approach is becoming a cornerstone of modern gynecological minimally invasive surgery, especially in leading training centers like World Laparoscopy Hospital.

For more information please log on to https://www.laparoscopyhospital.com