Laparoscopic visualisation of the ureters using near-infrared fluorescence imaging after retrograde indocyanine green injection in deep infiltrating endometriosis: the LAVIC trial

Abstract Objective To evaluate the feasibility and safety of intraureteral indocyanine green fluorescence for real-time ureter visualisation during laparoscopic surgery for deep infiltrating endometriosis. Materials and methods In this prospective, single-arm feasibility study, premenopausal women undergoing minimally invasive surgery for suspected deep infiltrating endometriosis received bilateral retrograde intraureteral indocyanine green following laparoscopic confirmation of the disease. Near-infrared fluorescence imaging was used for real-time ureteral visualisation. The primary outcome was the rate of successful ureteral visualisation. Secondary outcomes included fluorescence characteristics, the extent of ureterolysis, and procedure-related adverse events. Data were analysed primarily using descriptive statistics, with exploratory analyses performed where appropriate. Results Fifty-one patients with a mean age of 36 years were included. The mean duration of surgery was 217.3 ± 81.1 min. The mean duration of cystoscopy was 7.0 ± 5.0 min, and for intraureteral ICG injection 4.3 ± 3.3 min. Bilateral ureteral fluorescence was achieved in 50 of 51 patients (98%). Visualisation was immediate in all cases and persisted throughout surgery. Ureterolysis was required in 45% of patients. No ureteral injuries or ICG-related complications occurred. Conclusion Intraureteral ICG fluorescence appears feasible for real-time ureteral visualisation during complex surgery for deep infiltrating endometriosis. No adverse events attributable to intraureteral ICG administration were observed; however, its clinical utility requires further evaluation in comparative studies. Trial registration The trial protocol is registered at clinicaltrials.gov, NCT05206279