This video demonstrate Infrared Ureteral Stenting by Dr R K Mishra at World Laparoscopy Hospital. The infrared ureteral stent decreases the operative time of laparoscopic gynecological surgery and makes it a safer and more acceptable treatment option. The insertion of prophylactic ureteral stents in traditional gynecological surgery has been debated for a long time but use of lighted infrared stent is a new innovative technique.

Minimally invasive surgery has revolutionized gynecology, offering patients faster recovery, reduced postoperative pain, and minimal scarring. Among the challenges in gynecological laparoscopy is the risk of ureteral injury, especially during complex procedures like hysterectomy, endometriosis excision, or pelvic mass removal. Infrared ureteral stenting has emerged as a cutting-edge technique to enhance ureteral visualization and safety during these surgeries.

What is Infrared Ureteral Stenting?

Infrared ureteral stenting involves placing a ureteral stent that can be visualized using near-infrared (NIR) fluorescence imaging. Typically, the stent contains a dye or fluorescent marker (like indocyanine green, ICG) that emits infrared light when exposed to a specialized laparoscopic imaging system. This allows the surgeon to identify the ureter in real-time, reducing the risk of accidental injury.

Why is it Important in Gynecological Laparoscopy?

Ureteral injuries are rare but serious complications in gynecological surgeries. Conventional methods rely on anatomical knowledge and visual cues, which can be challenging in cases with distorted pelvic anatomy, severe endometriosis, or large fibroids. Infrared ureteral stenting provides:

1. Enhanced Visualization – The ureter glows under NIR imaging, clearly differentiating it from surrounding tissues.

2. Reduced Risk of Injury – Surgeons can confidently navigate around the ureter during dissection.

3. Real-Time Feedback – Any manipulation or tension on the ureter is immediately visible.

4. Minimally Invasive Monitoring – No additional incisions or complex instrumentation are required.

Procedure Overview

1. Preoperative Preparation – The patient is evaluated for ureteral stenting, and a fluorescent dye-compatible stent is selected.

2. Stent Placement – Under cystoscopic guidance, the ureteral stent is inserted into the ureter and positioned appropriately.

3. Laparoscopic Surgery – Using a near-infrared imaging laparoscope, the surgeon visualizes the fluorescent ureter throughout the procedure.

4. Postoperative Removal – The stent is removed after the surgery, typically within 24–48 hours if no complications are present.

Advantages over Conventional Methods

• Safety: Dramatically reduces inadvertent ureteral injury.

• Efficiency: Facilitates faster dissection by providing a clear anatomical roadmap.

• Adaptability: Useful in patients with prior pelvic surgeries, adhesions, or abnormal anatomy.

• Innovation: Represents the integration of fluorescence imaging into routine gynecologic practice.

Current Evidence

Recent studies have demonstrated that infrared ureteral stenting significantly decreases ureteral injury rates during laparoscopic hysterectomy and complex endometriosis surgery. Surgeons report improved confidence and reduced operative stress when the ureter is clearly visualized.

Future Perspectives

With the evolution of robotic-assisted laparoscopy and fluorescence imaging technology, infrared ureteral stenting may become standard practice for high-risk gynecological surgeries. Ongoing research is focused on improving dye formulations, stent designs, and imaging systems to further enhance safety and ease of use.

Conclusion

Infrared ureteral stenting in gynecological laparoscopy represents a significant advancement in surgical safety. By providing real-time, enhanced visualization of the ureters, it minimizes complications and allows surgeons to perform complex procedures with confidence. As technology continues to evolve, this technique is poised to become an essential tool in modern gynecologic minimally invasive surgery.