INTRODUCTION: While methylene blue remains the standard for chromopertubation, its diagnostic accuracy can be hindered by factors such as improper positioning of the uterine manipulator, variations in intrauterine pressure, and potential fallopian tube constriction, which can result in false-negative findings. In contrast, the use of indocyanine green (ICG), a fluorescent contrast agent, offers a groundbreaking alternative with enhanced visualization, enabling more reliable and consistent assessment of tubal patency. OBJECTIVE: This video aims to demonstrate the technique of ICG-based chromopertubation, showcasing its application in minimally invasive surgery for real-time tubal assessment, and highlighting its advantages over conventional methylene blue. METHODS: This video-based surgical demonstration features a step-by-step guide to ICG-based chromopertubation and its clinical application. ICG, a fluorescent contrast agent with a well-established safety profile, was prepared by diluting 0.5 mL (2.5 mg/mL) in 500 mL of normal saline. From this solution, 20 mL was instilled into the uterine cavity via a diagnostic uterine manipulator. This technique outlines the adequate concentration needed for achieving appropriate dilution to optimize visualization of tubal patency while minimizing dye overload. Intraoperative imaging was performed using near-infrared fluorescence (NIRF) technology integrated into the robotic surgical platform. The patient, a 36-year-old woman with abnormal uterine bleeding and a history of endometriosis, underwent robotic-assisted myomectomy, right ovarian cystectomy, and chromopertubation using ICG. RESULTS: ICG fluorescence imaging enabled clear, real-time visualization of the fallopian tubes and confirmed right-sided tubal patency with distal spill. The left tube was surgically absent. Compared to methylene blue, ICG provided superior visualization and reduced the risk of false-negative results caused by factors such as tubal spasm, intrauterine pressure, or uterine manipulator positioning. The procedure was completed without complications, and the patient’s reproductive anatomy was preserved. CONCLUSIONS: ICG-guided chromopertubation is a safe, effective, and technically feasible method for assessing tubal patency during minimally invasive gynecologic surgery. Its enhanced visualization and reliability make it a promising alternative to traditional dye-based methods, particularly in reproductive surgery where accurate tubal assessment is critical for fertility planning.
Mohr-Sasson et al. (Fri,) studied this question.