Applications of Near-Infrared Technology in Minimally Invasive Gynecologic Surgery

Introduction

In complex gynecologic surgery, proper identification of anatomy and careful dissection of tissue planes is imperative. Near-infrared Fluorescence (NIRF) with and without indocyanine green dye (ICG) is a technology that has traditionally been used in general surgery and gynecologic oncology mostly for tissue perfusion assessment and sentinel node mapping but has increasingly been applied in benign gynecologic surgery as a tool for anatomy identification and dissection.

Study Objective

The objectives of this video are to: 1) provide an overview of NIRF, 2) review applications of NIRF in benign gynecologic surgery, and 3) demonstrate examples of this technology with and without ICG in benign gynecologic surgery.

Design

Educational video highlighting applications of NIRF with and without ICG in benign gynecologic surgery.

Setting

Academic Medical Center.

Patients or Participants

Cases with relevant usage of NIRF-ICG.

Interventions

Gynecologic surgery.

Measurements and Primary Results

This video provides an overview of applications of NIRF with and without ICG in a variety of gynecologic surgical scenarios, including ureteral identification, bladder dissection, myomectomy, and isthmocele resection. We demonstrate identification of critical anatomy and dissection planes in complex cases, such as deep infiltrating endometriosis. We discuss varying routes and dosages of ICG for specific surgical purposes.

Conclusion

NIRF with and without ICG has a wide variety of applications in benign gynecologic surgery and can be a useful tool for identification of anatomy and dissection planes for both trainees and experienced surgeons.