Introduction The ureters, due to their close proximity to vital structures and pelvic organs, are prone to intra-operative injury. The risk varies between 0.5% and 5%, with the distal ureter being particularly vulnerable. This risk escalates with surgical complexity, distorted anatomy, and surgical technique. This video demonstrates the use of Indocyanine Green (ICG) to mitigate ureteric injury, a technique previously employed in urological, colorectal, and complex minimally invasive gynaecological surgeries. Our aim is to showcase novel approaches and highlight their advantages in real-time gynaecologic oncology surgery.

Description The video illustrates four methods of ureter identification using ICG: 1) Open approach with Spy-Phi camera, 2) Laparoscopic pinpoint camera 3) Laparoscopic 1788 camera, and 4) Laparoscopic with IRIS stents. The first three methods involve the intra-operative injection of ICG into the ureter via Pollock catheters, which are placed through cystoscopy and retrograde ureteric injection of ICG. The latter method demonstrates a similar approach using IRIS stents.

Conclusion/Implications The retrograde injection of ICG for ureteric illumination is a feasible and safe method for intra-operative ureter identification. This technique could prove invaluable in preventing intra-operative ureteric injury during complex surgeries, such as severe endometriosis resection, large uterus removal, and radical hysterectomy, or in cases of distorted or fibrosed retroperitoneum, like post-radiation patients. Further research is warranted to explore its potential applications.