First Reported Case of Acute Kidney Injury Following Intraureteral Indocyanine Green Administration During Bilateral Endometrioma Excision

Indocyanine green (ICG) is widely used in minimally invasive surgery for real-time fluorescence imaging of vascular, biliary, and urological structures. Although its intravenous use has been extensively validated, data on intraureteral administration remain scarce, particularly regarding renal safety. We report the case of a 50-year-old woman undergoing laparoscopic bilateral endometrioma excision with intraureteral ICG instillation for ureteral visualisation. Despite an uneventful surgery, the patient developed anuria and acute kidney injury (AKI) within 24 h, requiring temporary hemodialysis. Imaging demonstrated bilateral renal dysfunction without evidence of ureteral transection. Renal function gradually improved with supportive care, and dialysis was discontinued. This is, to our knowledge, the first reported case of AKI following intraureteral ICG use. Potential mechanisms include dye-induced tubular toxicity, ischemic injury, and multifactorial perioperative stressors. Given the increasing adoption of near-infrared fluorescence in gynecologic and urologic surgery, our case highlights the urgent need for systematic studies on the renal safety of intraureteral ICG administration. Until further evidence emerges, surgeons should use the technique with caution, particularly in patients with preexisting risk factors for AKI.