Application of indocyanine green (ICG)-guided surgery in clinical practice: lesson to learn from other organs—an overview on clinical applications and future perspectives

Cassinotti, Elisa; Boni, Luigi; Baldari, Ludovica

doi:10.1007/s13304-022-01361-y

Cited by 18 publications

(10 citation statements)

References 47 publications

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“…The dosages recommended in this study can thus solely be applied to perfusion evaluation. Currently, there are no standardized application methods for ICG usage in the different clinical contexts, although most studies are using dosages in a range similar to the range used for perfusion assessment [1,2]. Moreover, a widespread heterogeneity can be observed in the literature regarding the timepoint and localization of ICG application [1,23].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are no standardized application methods for ICG usage in the different clinical contexts, although most studies are using dosages in a range similar to the range used for perfusion assessment [1,2]. Moreover, a widespread heterogeneity can be observed in the literature regarding the timepoint and localization of ICG application [1,23]. Separate studies need to be conducted for each setting, focusing on potential differences in dosage and application of ICG in different surgical contexts, as already partly conducted by our group [20][21][22]24].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most promising recently developed techniques is indocyanine green (ICG) near-infrared fluorescence (NIRF), which is currently increasingly being applied across all surgical fields [1][2][3][4]. ICG-NIRF has gained recognition as a reliable real-time technique for visualizing tissue perfusion, e.g., enabling the precise placement of anastomoses and Life 2024, 14, 186 2 of 18 the identification of potential vascular compromise, potentially reducing perfusion-related complications [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

Lobbes,

Schier,

Tiebie

et al. 2024

Life

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Background: Indocyanine green (ICG) near-infrared fluorescence (NIRF) has emerged as a promising technique for visualizing tissue perfusion. However, within the wide range of dosages and imaging conditions currently being applied, the optimal dosage of ICG remains unclear. This study aimed to investigate the feasibility and implications of implementing lower dosages of ICG than commonly used for visual and quantitative perfusion assessment in a standardized setting. Methods: A prospective single-center cohort study was conducted on patients undergoing ileostomy reversal by hand-sewn anastomosis. ICG-NIRF visualization was performed before (T1) and after (T2) anastomosis with one of four different dosages of ICG (5 mg, 2.5 mg, 1.25 mg, or 0.625 mg) and recorded. Postoperatively, each visualization was evaluated for signal strength, completeness, and homogeneity of fluorescence. Additionally, perfusion graphs were generated by a software-based quantitative perfusion assessment, allowing an analysis of perfusion parameters. Statistical analysis comparing the effect of the investigated dosages on these parameters was performed. Results: In total, 40 patients were investigated. Visual evaluation demonstrated strong, complete, and homogeneous fluorescence signals across all dosages. Perfusion graph assessment revealed a consistent shape for all dosages (ingress followed by egress phase). While the average signal intensity decreased with dosage, it was sufficient to enable perfusion assessment even at the lowest dosages of 1.25 mg and 0.625 mg of ICG. The baseline intensity at T2 (the second intraoperative visualization) significantly decreased with dosage. The slope of the egress phase steepened with decreasing dosage. Conclusions: Lower dosages of ICG were sufficient for intraoperative perfusion assessment, while causing lower residual fluorescence and quicker egress in subsequent visualizations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

Lobbes,

Schier,

Tiebie

et al. 2024

Life

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“…In addition, it has been clinically used in hepatobiliary surgery and ophthalmic angiography for many years. 39 , 40 The principle of infrared fluorescence imaging is that after ICG enters the blood, it combines with hemoglobin, flows with the blood to various organs of the body and is finally taken up and metabolized in the liver. ICG in organs and blood vessels can be identified by infrared light waves and imaged on an infrared fluorescent display, thus providing navigation for clinical operations.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green-Loaded Nanobubbles Targeting Carbonic Anhydrase IX for Multimodal Imaging of Renal Cell Carcinoma

Zhong¹,

Chen²,

Liu³

et al. 2023

IJN

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Background and Purpose The early diagnosis and differential diagnosis of renal cell carcinoma (RCC) has always been a clinical difficulty and a research focus. Carbonic anhydrase IX (CA IX) is highly expressed on the cell membrane of RCC but is not expressed in normal renal tissues. In this study, nanobubbles (NBs) targeting CA IX with ultrasound and photoacoustic multimodal imaging capabilities were prepared to explore a new method for the diagnosis and differential diagnosis of RCC. Methods Indocyanine green (ICG)-loaded lipid NBs (ICG-NBs) were prepared by using the filming rehydration method, and anti-CA IX polypeptides (ACPs) were attached to their surfaces to prepare CA IX-targeted NBs (ACP/ICG-NBs). The particle size, zeta potential and ICG encapsulation efficiency of these nanobubbles were measured, and their specific targeting and binding abilities to RCC cells were determined. The in vitro and in vivo ultrasound, photoacoustic and fluorescence imaging characteristics of these nanobubbles were also assessed. Results The particle size of the ACP/ICG-NBs was 475.9 nm in diameter, and their zeta potential was −2.65 mV. Laser confocal microscopy and flow cytometry both confirmed that ACP/ICG-NBs had specific binding activity and ideal affinity to CA IX-positive RCC cells (786-O) but not to CA IX-negative RCC cells (ACHN). The intensities of the in vitro ultrasound, photoacoustic and fluorescence imaging were positively correlated with the concentrations of ACP/ICG-NBs. In in vivo ultrasound and photoacoustic imaging experiments, ACP/ICG-NBs exhibited specific enhanced ultrasound and photoacoustic imaging effects in 786-O xenograft tumors. Conclusion The ICG- and ACP-loaded targeted nanobubbles that we prepared had the capability of ultrasound, photoacoustic and fluorescence multimodal imaging and could specifically enhance the ultrasound and photoacoustic imaging of RCC xenograft tumors. This outcome has potential clinical application value for the diagnosis of RCC at the early stage and the differential diagnosis of benign and malignant kidney tumors.

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“…In the gynaecological eld, recently published systematic reviews recommend the use of ICG as the tracer of choice for most gynaecological cancers [5].…”

Section: Introductionmentioning

confidence: 99%

New Clinical Application of Indocyanine Green in Fluorescence- Guided Laparoscopic Lymph-node Biopsy in Case of Lymphoma. Preliminary Results on a Case Series

Casaccia

Ibatici²,

Ballerini

et al. 2023

Preprint

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Background Indocyanine Green (ICG) fluorescence-guided surgery is widely used for intraoperative visualization of lymphatic structures. To date, there are no reports indicating this dye being used in lymph node biopsies for suspected or relapsed lymphoma.Methods Between October 2021 and June 2022, 12 patients underwent a fluorescence-guided laparoscopic lymph node biopsy (FGLLB) using ICG. The following was retrospectively evaluated: the dosage of ICG, the injection site, the number of patients where fluorescence was obtained after ICG administration, and additionally, the parameters indicating the outcome of the surgical procedure.Results The median duration of the surgery was 90 minutes. A laparotomy conversion was required in one case due to bleeding. Fluorescence was obtained in 10/12 (83.3%) patients by means of subcutaneous/perilesional injection in six of the patients, and intravenously in the other four. Hospitalization had a mean duration of three days. There were no major postoperative complications. FGLLB was used in seven patients to follow lymphoproliferative disease progression, and in five patients to establish a diagnosis. In all cases, FGLLB provided the information necessary for the correct diagnosis.Conclusions Fluorescence with ICG offers a simple and safe method for detecting pathological lymph nodes. FGLLB in suspected intra-abdominal lymphoma can largely benefit from this new opportunity which has not yet been tested to date. Further studies with large case series are needed to confirm its efficacy.

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Application of indocyanine green (ICG)-guided surgery in clinical practice: lesson to learn from other organs—an overview on clinical applications and future perspectives

Cited by 18 publications

References 47 publications

Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

Indocyanine Green-Loaded Nanobubbles Targeting Carbonic Anhydrase IX for Multimodal Imaging of Renal Cell Carcinoma

New Clinical Application of Indocyanine Green in Fluorescence- Guided Laparoscopic Lymph-node Biopsy in Case of Lymphoma. Preliminary Results on a Case Series

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