Intra-ureteric indocyanine green for ureteric visualisation in complex benign gynaecological surgery: a prospective series of 50 cases

Ureteric injury is a serious complication of gynaecological surgery, particularly in cases involving deep endometriosis. This prospective cohort study assessed the feasibility and safety of intra-ureteric indocyanine green (ICG) for real-time ureteric visualisation in complex endometriosis surgery at a tertiary referral unit. Fifty consecutive patients undergoing laparoscopic procedures received cystoscopy-guided bilateral intra-ureteric ICG. Mean additional operative time was 160 seconds. Bilateral ureteric fluorescence was achieved in all cases and persisted throughout surgery. Guidewires and intra-operative stents were required in 2% and 4% of cases, respectively. No ICG-related adverse events or ureteric injuries occurred, demonstrating a rapid, safe and reproducible technique.