{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:41:41Z","timestamp":1792651301729,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for &gt;5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 \u00b1 1.13 g\/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP.<\/jats:p>","DOI":"10.3390\/jpm13091345","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T11:31:18Z","timestamp":1693481478000},"page":"1345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5876-3703","authenticated-orcid":false,"given":"Jiyoun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1433-2690","authenticated-orcid":false,"given":"Su Hyeon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Wook","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-La","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo Seong","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang 10414, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Ju","family":"Seong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Sun","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/PL00004045","article-title":"Ureteral injuries during gynecological surgery","volume":"12","author":"Liapis","year":"2001","journal-title":"Int. Urogynecol. J. Pelvic. Floor Dysfunct."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4111\/kju.2012.53.2.120","article-title":"Ureteral injury in gynecologic surgery: A 5-year review in a community hospital","volume":"53","author":"Park","year":"2012","journal-title":"Korean J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1067\/mob.2000.111298","article-title":"Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse","volume":"183","author":"Barber","year":"2000","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","first-page":"49","article-title":"The implications of lighted ureteral stenting in laparoscopic colectomy","volume":"6","author":"Chahin","year":"2002","journal-title":"JSLS J. Soc. Laparoendosc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"436.e1","DOI":"10.1016\/j.ajog.2014.05.017","article-title":"Indocyanine green for intraoperative localization of ureter","volume":"211","author":"Siddighi","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.ajog.2015.10.150","article-title":"Prevention of iatrogenic ureteral injuries during robotic gynecologic surgery: A review","volume":"214","author":"Lee","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Polom, J., Kalinowski, L., Diana, M., Chand, M., Caballero, C., Sawicki, S., and Polom, K. (2021). Comprehensive review of fluorescence applications in gynecology. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194387"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"31","DOI":"10.21037\/ls-20-98","article-title":"A narrative review of fluorescence imaging in robotic-assisted surgery","volume":"5","author":"Lee","year":"2021","journal-title":"Laparosc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s00345-019-02870-z","article-title":"Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF\/ICG)-guided robotic urologic surgery: A systematic review-based expert consensus","volume":"38","author":"Cacciamani","year":"2020","journal-title":"World J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1097\/IGC.0b013e3182a616f6","article-title":"Detection of sentinel nodes for endometrial cancer with robotic assisted fluorescence imaging: Cervical versus hysteroscopic injection","volume":"23","author":"Rossi","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jmig.2020.04.004","article-title":"Use of Indocyanine Green for Intraoperative Perfusion Assessment in Women with Ureteral Endometriosis: A Preliminary Study","volume":"28","author":"Raimondo","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3442","DOI":"10.1021\/acs.molpharmaceut.8b00427","article-title":"Intraoperative Ureter Visualization Using a Novel Near-Infrared Fluorescent Dye","volume":"15","author":"Mahalingam","year":"2018","journal-title":"Mol. Pharm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.eururo.2014.08.057","article-title":"Use of indocyanine green during robot-assisted ureteral reconstructions","volume":"67","author":"Lee","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Raffone, A., Raimondo, D., Oliviero, A., Raspollini, A., Travaglino, A., Torella, M., Riemma, G., La Verde, M., De Franciscis, P., and Casadio, P. (2022). The Use of Near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR-ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature. Medicina, 58.","DOI":"10.3390\/medicina58060792"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.jmig.2022.01.018","article-title":"Robotic-assisted Laparoscopic Ureterolysis for Deep Infiltrating Endometriosis using Indocyanine Green Under Near-Infrared Fluorescence","volume":"29","author":"Thigpen","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1136\/ijgc-2019-000895","article-title":"Intra-operative identification of ureters using indocyanine green for gynecological oncology procedures","volume":"30","author":"Cabanes","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ucl.2005.11.005","article-title":"Ureteral injuries: External and iatrogenic","volume":"33","author":"Elliott","year":"2006","journal-title":"Urol. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jmig.2014.01.006","article-title":"Urinary tract injuries in laparoscopic hysterectomy: A systematic review","volume":"21","author":"Adelman","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jmig.2018.01.004","article-title":"Rate of urologic injury with robotic hysterectomy","volume":"25","author":"Petersen","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/GCO.0000000000000793","article-title":"Intraoperative dyes, fluorescence and enhanced imaging in benign gynaecologic surgery","volume":"34","author":"Shibata","year":"2022","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1177\/1553350619827152","article-title":"Real-Time visualization of ureters using indocyanine green during laparoscopic surgeries: Can we make surgery safer?","volume":"26","author":"Mandovra","year":"2019","journal-title":"Surg. Innov."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1111\/codi.15407","article-title":"Intraureteral indocyanine green augments ureteral identification and avoidance during complex robotic-assisted colorectal surgery","volume":"23","author":"White","year":"2021","journal-title":"Color. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.amjsurg.2021.07.012","article-title":"Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections","volume":"223","author":"Soriano","year":"2022","journal-title":"Am. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s10151-019-01973-4","article-title":"Currently available and experimental dyes for intraopera tive near-infrared fluorescence imaging of the ureters: A systematic review","volume":"23","author":"Slooter","year":"2019","journal-title":"Tech. Coloproctol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.eucr.2017.02.006","article-title":"Anaphylactic shock after intravenous administration of indocyanine green during robotic partial nephrectomy","volume":"12","author":"Chu","year":"2017","journal-title":"Urol. Case Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jmig.2019.08.026","article-title":"Laparoscopic Variants of Temporary Uterine Artery Ligation","volume":"27","author":"Carranco","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/1553350620968990","article-title":"Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach ap plying intraoperative indocyanine green fluorescence","volume":"28","author":"Ferreira","year":"2021","journal-title":"Surg. Innov."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/aogs.13971","article-title":"Indocyanine green in the surgical management of endometriosis: A systematic review","volume":"100","author":"Ianieri","year":"2021","journal-title":"Acta Obstet Gynecol Scand."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/9\/1345\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:43:35Z","timestamp":1760129015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/9\/1345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,31]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jpm13091345"],"URL":"https:\/\/doi.org\/10.3390\/jpm13091345","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,31]]}}}