Applications of ICG and Near-Infrared Fluorescence for Uterine Isthmocele Repair

INTRODUCTION: The most common approach for uterine isthmocele repair requires two surgeons for dual hysteroscopy and laparoscopy for identification and excision of the thinned myometrial tissues. In this video, we demonstrate a novel application of indocyanine green and near-infrared fluorescene to aid with identification of a uterine isthmocele defect, and describe the technique which allows a single surgeon to perform the repair. OBJECTIVE: We seek to illustrate a surgical approach in which indocyanine green is used to dye the endocervical and endometrial tissues in order to guide a robotic-assisted laparoscopic uterine isthmocele repair. METHODS: A single surgery was recorded demonstrating the above technique. Key steps and surgical techniques are highlighted in this video. RESULTS: A successful application of indocyanine green and near-infrared fluorescence for the detection and repair of uterine isthmocele defect is demonstrated. CONCLUSIONS: Intracavitary injection of indocyanine green in combination with near-infrared fluorescence for identification and repair of uterine isthmocele is a simple surgical technique that enables a single surgeon to perform this case in a minimally invasive manner.