Watch this detailed video on Total Laparoscopic Hysterectomy (TLH) with Indocyanine Green (ICG) guidance. This step-by-step surgical video demonstrates the minimally invasive technique, highlighting precision, safety, and enhanced visualization using ICG. Ideal for surgeons, trainees, and medical enthusiasts looking to understand advanced laparoscopic gynecological procedures.

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 ureteral branch, bladder, and the ureter. The fluorescent signals were processed by a digital video system and displayed on a TV monitor in real-time.

Total Laparoscopic Hysterectomy (TLH) has become the gold standard for managing various benign and malignant gynecological conditions, offering patients a minimally invasive option with faster recovery, reduced pain, and smaller scars compared to traditional open surgery. Recent advancements, such as the use of Indocyanine Green (ICG) dye, have further enhanced the safety and precision of this procedure.

What is Total Laparoscopic Hysterectomy?
TLH is a minimally invasive surgical procedure in which the uterus is removed entirely using laparoscopic instruments inserted through small abdominal incisions. It is commonly indicated for conditions like fibroids, adenomyosis, abnormal uterine bleeding, and early-stage endometrial or cervical cancer.

Role of Indocyanine Green in TLH
Indocyanine Green is a fluorescent dye used in medical imaging. When injected intravenously during surgery, ICG binds to plasma proteins and fluoresces under near-infrared light, allowing surgeons to visualize blood vessels, lymphatics, and perfusion in real-time. In TLH, ICG offers several advantages:

Enhanced Visualization of Uterine and Ovarian Blood Supply: ICG helps identify uterine arteries and their branches, reducing the risk of accidental injury and excessive bleeding.

Improved Lymphatic Mapping: For patients undergoing TLH for malignancy, ICG can highlight pelvic lymph nodes, aiding in accurate staging and lymphadenectomy.

Safer Dissection: Fluorescence-guided imaging helps distinguish critical structures like ureters, reducing the risk of intraoperative complications.

Step-by-Step Overview of TLH with ICG:

Patient Preparation: Under general anesthesia, the patient is positioned in lithotomy with a slight Trendelenburg tilt.

Port Placement: Small incisions are made for laparoscopic ports, typically including one umbilical port for the camera.

ICG Injection: A calculated dose of Indocyanine Green is administered intravenously.

Fluorescence Imaging: Using a near-infrared camera, the surgeon visualizes uterine vasculature, ureters, and lymphatics.

Dissection and Removal: The uterus is carefully dissected from its attachments and removed, often through the vagina or morcellation.

Hemostasis and Closure: Ensuring proper blood flow and hemostasis, the ports are closed, and the procedure is completed.

Benefits of Using ICG in TLH:

Reduced intraoperative bleeding

Lower risk of ureteral or vascular injury

Better lymph node identification in oncologic cases

Faster postoperative recovery due to precise, minimal tissue trauma

Conclusion
Total Laparoscopic Hysterectomy with Indocyanine Green represents a significant advancement in gynecological surgery. By combining minimally invasive techniques with real-time fluorescence imaging, surgeons can perform safer, more precise procedures, improving patient outcomes and recovery. As technology continues to evolve, fluorescence-guided surgery is likely to become a standard component in advanced gynecologic procedures.