Watch this detailed video on Total Laparoscopic Hysterectomy with Indocyanine Green (ICG), demonstrating advanced visualization techniques to improve surgical precision and safety. This video explains how ICG fluorescence helps in better identification of anatomical structures, vascular supply, and tissue perfusion during minimally invasive gynecologic surgery. Ideal for surgeons, gynecologists, and medical students who want to enhance their knowledge of modern laparoscopic hysterectomy techniques.

Conventional Total Laparoscopic Hysterectomy is the standard surgical procedure for treating uterine diseases. The procedure involves the removal of the uterus and the surgery involves cutting the uterine artery, separating the ureter tunnel, and performing bladder separation and colpotomy. The procedure is frequently associated with postoperative insufficiency of ureteral blood supply and repair problems. This can lead to significant ureteral complications, such as postoperative ischemic necrosis, urinary fistula, stenosis, etc. ICG 25 mg was mixed with 10 mL sterile water, and 5 ml of the dilution was injected in both the ureter. The dye was tracked intraoperatively in real-time using an infrared fluorescence laparoscopic system (Endoscope Camera Fluorescent System; Stryker 1688 in order to reveal the ureteral branch, bladder, and ureter. The fluorescent signals were processed by a digital video system and displayed on a TV monitor in real-time.

Total Laparoscopic Hysterectomy (TLH) with Indocyanine Green (ICG) is an advanced minimally invasive surgical technique that combines standard laparoscopic hysterectomy with fluorescence imaging technology to improve surgical safety and precision. This approach is increasingly used in complex benign gynecologic conditions, endometriosis surgery, and oncologic procedures where visualization of vital structures and tissue perfusion is critical.

Total Laparoscopic Hysterectomy is a procedure in which the uterus is completely removed using laparoscopic instruments through small abdominal incisions. Compared with open surgery, TLH offers benefits such as reduced blood loss, less postoperative pain, faster recovery, and shorter hospital stay. The integration of Indocyanine Green (ICG) fluorescence further enhances intraoperative visualization. ICG is a water-soluble dye that binds to plasma proteins after intravenous injection and emits fluorescence when exposed to near-infrared light, allowing real-time visualization of blood flow, lymphatics, and vital anatomical structures.

In TLH, ICG is mainly used for tissue perfusion assessment, ureteral identification, and vascular mapping. For example, studies have shown that using ICG to assess ureteral vascularity during hysterectomy significantly reduces ureter-related complications, particularly in complex surgeries such as deep endometriosis or radical hysterectomy. Additionally, ICG fluorescence can be used to evaluate vaginal cuff perfusion during TLH, helping surgeons ensure adequate blood supply and potentially reducing postoperative complications such as cuff dehiscence.

The safety profile of ICG is generally excellent. It is rapidly cleared by the liver and excreted in bile, with a short half-life and minimal adverse reactions when used in recommended doses. However, it should be avoided in patients with iodine allergy. The typical clinical dose varies depending on surgical purpose but is usually well below toxicity thresholds.

Overall, TLH with ICG fluorescence represents a major advancement in minimally invasive gynecologic surgery. By providing real-time functional imaging in addition to anatomical visualization, it enhances surgical precision, reduces complication risk, and improves patient outcomes. As imaging technology and surgical expertise continue to evolve, the role of fluorescence-guided surgery in gynecology is expected to expand further.

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