Intraoperative bladder visualization by indocyanine green filling and subsequent washout in endoscopic hysterectomy: ICG-Washout method.

INTRODUCTION: Despite a potential risk of bladder injury in laparoscopic hysterectomy (LH) and robot-assisted LH (RaLH), an intraoperative method for delineating the entire bladder with indocyanine green (ICG) has not been established. METHODS: We conducted a preliminary experiment using porcine bladders to verify the appropriate amount of ICG for intraoperative bladder visualization. Afterward, intraoperative bladder visualization was tried in LH and RaLH in two patients suspected of having adhesions around the bladder after previous abdominal surgery. RESULTS: Although near-infrared (NIR) fluorescence was well observed through the wall of the porcine bladder filled with ICG solution at a concentration of 0.024 mg/mL, the subsequent replacement of the ICG solution with saline made the NIR fluorescence brighter. In both patients, the bladder was successfully delineated by NIR fluorescence after filling the bladder with ICG solution and the subsequent washout with saline. CONCLUSION: The ICG-Washout method for locating the bladder by NIR fluorescence could be useful in LH and RaLH.

Spatio-temporal distribution of eosinophils in the mouse uterus during peri-implantation period.

Embryo implantation is an immunologically paradoxical event. In humans and rodents, blastocysts adhere to uterine epithelium and then invade into endometrial stroma, while maternal body is protected from extraneous materials by its immune system. Eosinophils, a kind of leucocytes involving parasitic infections and allergic response, increase in number in uterus when serum estrogen level is elevated during estrus cycles. However, response of uterine eosinophils to ovarian estrogen during peri-implantation period is not clear. Therefore, we investigated the distribution of eosinophils in murine peri-implantation uterus. On day 0.5 of pregnancy, eosinophils were found primarily in endometrial stroma near the luminal epithelium, whereas they were primarily distributed in basal endometrium and myometrium on day 3.5 of pregnancy. The number of uterine eosinophils on day 4.5 of pregnancy was significantly increased by inhibition of maternal estrogen action. Collectively, our results indicate that the ovarian estrogen negatively regulates uterine eosinophil distribution during peri-implantation period and provide insight into a role of maternal immune system in embryo implantation.