Overlay Visualization of the Ureter Using a Fully Intraluminal Indocyanine Green-Emitting Stent During Laparoscopic Surgery for Diverticular Disease: A Technical Note

Ureteral injury during laparoscopic surgery for diverticular disease remains an uncommon but clinically significant issue. Chronic inflammation and fibrosis frequently obscure retroperitoneal anatomy. To describe a workflow-integrated technique using a fully intraluminal indocyanine green (ICG)-emitting ureteral stent that enables on-demand overlay visualization using a single near-infrared (NIR) platform. A fully intraluminal ICG-emitting ureteral stent was placed cystoscopically before surgery. During laparoscopy, NIR overlay mode was activated selectively at predefined high-risk steps: before peritoneal incision, during medial-to-lateral dissection around the inferior mesenteric vessels, and after colonic mobilization. Fluorescent signals were superimposed on white-light imaging to confirm ureteral position without interrupting dissection. Overlay visualization allowed rapid and repeatable confirmation of ureter location. Real-time shared situational awareness was improved for the entire operative team. No intraoperative ureteral injury occurred. Adverse events were limited to those attributable to cystoscopic stent placement. On-demand overlay visualization using a fully intraluminal ICG-emitting ureteral stent represents a practical adjunct in laparoscopic surgery for complex diverticular disease. This technique supports organ-preserving surgery by enabling continuous dissection with real-time ureter awareness using a single imaging system.