Fluorescence Ureteral Visualization in Human Laparoscopic Colorectal Surgery Using Methylene Blue

Mahdi Al-Taher*, Jacqueline van den Bos, Rutger M. Schols, Nicole D. Bouvy, Laurents P. S. Stassen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Ureteral injury during laparoscopic surgery is rare, but when it occurs, it can be a serious problem. Near-infrared fluorescence (NIRF) with methylene blue (MB) administration is a promising technique for easier and potentially earlier intraoperative visualization of the ureter. Aim of this prospective study was to assess the feasibility of NIRF imaging of the ureter during laparoscopic colorectal surgery, using MB. Methods: Patients undergoing laparoscopic colorectal surgery were included and received intravenous injection of MB preoperatively. The ureter was visualized using a laparoscope, which offered both conventional and fluorescence imaging. Intraoperative recognition of the ureter was registered. The precision of ureter distinction with MB imaging was compared to the conventional laparoscopic view. Results: Ten patients were included. All procedures were initially performed using a laparoscopic approach. Dose per injection ranged between 0.125 mg/kg and 1.0 mg/kg bodyweight. There were no adverse effects attributable to MB administration. The ureter was successfully detected in five patients, with highest contrast between ureter and surrounding tissue at an administered dose of 0.75-1.0 mg/kg. The fluorescent signal was only picked up after the ureter was already visible in the conventional white light mode. Conclusion: Ureteral fluorescence imaging using MB proved to be safe and feasible. However, the present technique does not provide practical advantage over conventional laparoscopic imaging for identification of the ureter during laparoscopic colorectal surgery. Future research is necessary to explore more extensive dose finding, alternative fluorescent dyes, or improvement of the imaging system to make this application clinically beneficial.
Original languageEnglish
Pages (from-to)870-875
JournalJournal of Laparoendoscopic & Advanced Surgical Techniques
Issue number11
Publication statusPublished - Nov 2016


  • near-infrared fluorescence imaging
  • ureter
  • methylene blue
  • laparoscopic colorectal surgery
  • urology


Dive into the research topics of 'Fluorescence Ureteral Visualization in Human Laparoscopic Colorectal Surgery Using Methylene Blue'. Together they form a unique fingerprint.

Cite this