Watch this detailed surgical video on Total Laparoscopic Hysterectomy and BSO with Ureteric Mapping using ICG. This educational video demonstrates step-by-step surgical technique, anatomical landmarks, ureter safety mapping using ICG fluorescence, and key tips to improve surgical outcomes. This video is ideal for gynecologic surgeons, laparoscopic trainees, and medical professionals interested in advanced minimally invasive surgery.

This video demonstrate Total Laparoscopic Hysterectomy and Bilateral Salpingectomy with Ureteric Mapping using ICG. Indocyanine green (ICG) represents a feasible alternative to the more traditional methods of ureteric mapping during Total Laparoscopic Hysterectomy, and interest in this promising tracer is growing. This video outlines our experience with ICG in a minimally invasive laparoscopic approach in women with DUB using the STRYKER ICG near-infrared fluorescence imaging technology. All patients had undergone simple or laparoscopic hysterectomy with ureteric mapping by means of an intraurethral injection of ICG dye with locations of the ureter after the induction of general anesthesia. The detection rate of ICG in the ureter was 100 %. All procedures were successfully completed without conversion to open laparotomy, and no intraoperative or postoperative complications occurred. In our preliminary experience, ICG showed a high overall detection rate, and bilateral mapping appears to be a feasible alternative to the more traditional methods of ureteric mapping with a positive impact on patient management.

Total Laparoscopic Hysterectomy (TLH) with Bilateral Salpingo-Oophorectomy (BSO) and Ureteric Mapping using Indocyanine Green (ICG) is an advanced minimally invasive gynecological procedure designed to improve surgical safety, precision, and outcomes, particularly in complex pelvic surgeries.

Total Laparoscopic Hysterectomy involves complete removal of the uterus using laparoscopic techniques, while BSO refers to the removal of both fallopian tubes and ovaries. This combined procedure is commonly performed for conditions such as fibroids, abnormal uterine bleeding, endometriosis, gynecologic malignancy, or prophylactic risk-reducing surgery. The laparoscopic approach offers benefits including reduced postoperative pain, shorter hospital stay, faster recovery, and improved cosmetic outcomes compared to open surgery.

One of the major concerns during hysterectomy is the risk of ureteric injury, especially in cases with distorted pelvic anatomy, adhesions, or malignancy. Ureteric injuries are uncommon but can lead to serious complications if not detected early. The use of ICG fluorescence imaging has emerged as an important advancement to enhance intraoperative ureter visualization and reduce the risk of iatrogenic injury.

Indocyanine Green is a safe near-infrared fluorescent dye that emits light when exposed to NIR imaging systems, allowing real-time visualization of anatomical structures such as ureters and vascular supply. When ICG is instilled into the ureter via catheterization or cystoscopy, surgeons can clearly identify the ureteral course throughout the procedure, even in difficult surgical fields.

During TLH with BSO and ICG ureteric mapping, the procedure typically includes laparoscopic port placement, pelvic inspection, ureteric mapping using ICG under NIR imaging, dissection of the uterine pedicles, removal of uterus with adnexa, and secure closure of the vaginal cuff. ICG fluorescence helps surgeons confirm safe dissection planes and identify critical structures, thereby enhancing surgical confidence and accuracy.

Clinical evidence suggests that the use of ICG can significantly reduce ureter-related complications in complex hysterectomies. In some studies, ureteric complication rates in high-risk hysterectomy cases decreased dramatically when ICG assessment was used compared to procedures performed without it.

Overall, TLH with BSO and ureteric mapping using ICG represents a step toward precision, image-guided gynecologic surgery. It improves intraoperative visualization, enhances safety, and supports better patient outcomes, especially in complex or high-risk pelvic surgeries. Ongoing research continues to evaluate its long-term impact and expand its use across minimally invasive gynecologic procedures.