Initial experience of ureteric visualization using methylene blue during laparoscopy for gynecological surgery

Area of Science:

• Surgical Innovation
• Medical Imaging
• Gynecology

Background:

• Iatrogenic ureteral injury is a significant complication in gynecological surgeries, occurring in up to 1.5% of cases.
• Accurate ureteral identification is crucial to prevent such injuries during laparoscopic procedures.

Purpose of the Study:

• To evaluate the effectiveness and safety of using methylene blue (MB) for ureteral visualization in gynecological laparoscopic surgeries.
• To explore the novel simultaneous dual fluorescence imaging of ureters (MB) and sentinel lymph nodes (SLN) (Indocyanine Green - ICG).

Main Methods:

• Prospective study involving patients undergoing gynecological laparoscopic surgery.
• Intravenous administration of MB for ureteral fluorescence; ICG injected for SLN imaging when indicated.
• Comparison of outcomes between patients receiving MB (Group A) and a control group (Group B).

Main Results:

• MB fluorescence successfully visualized 90% of ureters in 25 patients (Group A).
• Ureteral fluorescence persisted for 15-20 minutes post-infusion, with 64% visibility at surgery's end.
• Zero iatrogenic ureteral injuries were observed in Group A, compared to 1.3% in Group B; adverse event rates were similar.

Conclusions:

• Methylene blue fluorescence is an effective and safe method for ureteral visualization during gynecological surgery.
• This technique can potentially decrease the incidence of iatrogenic ureteral injury without additional risks.
• Dual fluorescence imaging with MB and ICG offers a promising advancement for clinical application.