Secure and Reliable Infrared Light-Assisted Uterine Artery Transection and Colpotomy

INTRODUCTION: Uterine artery ligation followed by transection and colpotomy represents two of the final yet most critical steps of a hysterectomy. This surgical video presents a demonstration of reverse infrared fluorescence imaging for secure and reproducible uterine artery transection and colpotomy. OBJECTIVE: To 1) highlight instruments and technology available to perform safe surgery, 2) demonstrate the use of infrared backlighting for reliable colpotomy identification, and 3) showcase laparoscopic and robotic application of infrared lens assistance to reliably secure the uterine arteries. METHODS: This video presents a case series of 3 surgical patients with accompanying operative video taking place at a tertiary care referral center for minimally invasive gynecologic surgery and gynecologic oncology. During the time of uterine artery ligation, an illumination-capable uterine manipulator and robotic or endoscopic fluorescence imaging lens are utilized in order to identify the uterine artery, safely ligate at the level of the colpotomy, and perform colpotomy with efficient hemostatic technique. Of note, no fluorescent dye is necessary to perform this technique. RESULTS: All patients showcase the use of reverse infrared transillumination that identifies the uterine artery, colpotomy site, and successful vasculature transection with clear clinical hemostatic benefit. CONCLUSIONS: Infrared light-assisted uterine artery ligation and transection is safe, secure, reliable, and reproducible. It may be performed during robotic or traditional laparoscopic surgery. This technique may be used for a variety of gynecologic pathologies, and is suitable for application for all surgical skill levels.