# Unveiling the Invisible: Complication of Laparoscopic Sacrocolpopexy Illuminated by Transcervical Injection of ICG

## TL;DR

A patient with persistent vaginal discharge after a laparoscopic procedure was successfully treated using ICG injection to identify a hidden abscess.

## Contribution

The use of transcervical ICG injection is presented as an innovative method for visualizing hidden complications after laparoscopic sacrocolpopexy.

## Key findings

- ICG injection illuminated a retroperitoneal sinus and low-volume abscess in a post-sacral promontory area.
- The patient remained asymptomatic and satisfied after a successful laparoscopic revision procedure.
- ICG injection provided valuable insights for managing complex postoperative complications.

## Abstract

A 57-year-old patient was referred to our tertiary referral urogynecology unit due to persistent and profuse vaginal discharge 1 year after undergoing laparoscopic sacrocolpopexy with subtotal hysterectomy for apical prolapse. During clinical examination, abundant yellowish discharge from the cervix was observed. Creatinine testing and Uro-CT excluded vesicovaginal or ureterovaginal fistulas and large abscesses. However, owing to suspected infection and the patient’s poor quality of life, a decision was made to proceed with laparoscopic revision.

Intraoperatively, transcervical injection of ICG (indocyanine green) successfully illuminated a hidden retroperitoneal sinus and a low-volume abscess extending to the sacral promontory. Therefore, the previously installed mesh and the cervix were removed in a challenging but complication-free procedure. The patient was followed up after 3 months, remaining asymptomatic and satisfied with the outcome.

Managing complications following laparoscopic sacrocolpopexy requires thorough clinical and instrumental evaluation. In this case, the strategic use of ICG injection proved to be an innovative approach to visualizing hidden complications, offering valuable insights for handling complex scenarios.

The online version contains supplementary material available at 10.1007/s00192-025-06148-4.