Indocyanine Green Ureteral Mapping in Complex Pelvic Surgery

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Intraoperative ureteral injury is a risk in complex pelvic surgeries.
• Accurate ureteral identification is crucial for patient safety.

Purpose of the Study:

• To demonstrate the utility of indocyanine green (ICG) ureteral mapping using near-infrared (NIR) fluorescence.
• To discuss risks of ureteral injury during robotic pelvic procedures.
• To review relevant anatomy and common injury sites.

Main Methods:

• Live ureteral mapping using ICG and NIR fluorescence was performed in three robotic pelvic surgeries.
• Surgical techniques and ICG instillation steps were demonstrated.

Main Results:

• Bilateral ureters were successfully visualized throughout all procedures.
• Cases included total robotic hysterectomy and robotic sacrocolpopexy.
• All patients were discharged same-day and remained complication-free.

Conclusions:

• ICG ureteral mapping provides effective visual feedback in robotic pelvic surgery.
• This technique complements surgical skill to minimize iatrogenic ureteral injury.
• Larger prospective studies are required to validate the reduction in ureteral injury.