First Experience with Fluorescence in Pediatric Laparoscopy

Abstract

Background The use of intraoperative fluorescence images with indocyanine green (ICG) has recently been described as an aid in decision-making during surgical procedures in adults.We present our first experiences with different laparoscopic procedures performed in children using ICG fluorescence images. Material and Method We have used ICG fluorescence imaging technique in varicocele ligation, two nephrectomies, cholecystectomy, and one case of aortocoronary fistula closure. All procedures were performed through a minimally invasive approach. A high definition camera equipped with a visible infrared light source and gray-scale vision technology was used.After injection of ICG before or during the laparoscopic procedure, precise identification of vascular anatomy and bile duct architecture were easily identified. Fluorescence helped to assess blood flow from the spermatic vessels, define the variability of renal vascularization, and determine the precise location of the aortocoronary fistula. Biliary excretion of the ICG allowed the definition of the biliary tract. Conclusion Fluorescein-assisted images allowed a clear definition of the anatomy and safe surgical maneuvers during surgical procedures. The ICG imaging system seems to be simple and safe. Larger and more specific studies are needed to confirm its applicability, expand its indications, and address its advantages and disadvantages.

The Use of Indocyanine Green Fluorescence Angiography in Pediatric Surgery: A Systematic Review and Narrative Analysis

“…Other studies either overlooked stating the patient's weight, administration route, or ICG dilution making it difficult to generalize results. Injections were done intraoperatively except for specific indications including surgical procedures for primary ( 70 ) and metastatic ( 16 , 44 , 59 , 64 ) hepatoblastoma and biliary atresia ( 34 ) as well as cholecystectomies ( 22 , 23 , 28 , 31 ) for which ICG was injected from 18 to 72 h before the surgery.…”

“…In pediatric surgery and pediatric urology, ICG-FA indications included cholecystectomy ( n = 8) ( 13 , 14 , 22 , 23 , 26 , 28 , 31 , 55 ), primary and metastatic hepatoblastoma ( n = 6) ( 16 , 44 , 48 , 59 , 64 , 70 ), varicocelectomy ( n = 5) ( 22 , 24 – 26 , 31 ), nephrectomy ( n = 5) ( 22 , 25 , 26 , 28 , 32 ), chylous leaks and ascites ( n = 4) ( 15 , 47 , 51 , 56 ), colorectal procedures including cloacal, anorectal malformation, and Hirschsprung reconstructions, intestinal resection for volvulus, as well as stoma closure ( n = 4) ( 37 , 53 , 55 , 69 ), hepatocellular carcinoma ( n = 1) ( 18 ), abdominal mass excision ( n = 1) ( 22 ), and tracheoesophageal fistula ( n = 1) ( 58 ). Pediatric neurosurgeons used ICG-FA in patients with Moyamoya disease to evaluate the anatomy and confirm patency of their surgical anastomoses ( n = 4) ( 9 , 35 , 36 , 62 ).…”

Fluorescence Imaging Using Indocyanine Green Dye in the Pediatric Population

“…Some of the recent reports have demonstrated its successful application in the pediatric population (Table 5). [8][9][10][11][12][13] The primary intent of our current study was to retrospectively review our general use and dosing practices with the intraoperative administration of ICG to pediatric patients over a 2-year period. Over this period, 112 doses of ICG were administered to 100 patients for procedures including laparoscopic cholecystectomy, colorectal surgery, and renal procedures.…”

Laparoscopic Partial Splenectomy Assisted by Fluorescence in a 13-Year-Old Girl

“…The use of gray-scale cameras versus others in black and white is recommended, since although both capture ICG fluorescence, the firsts improve the visualization of the surgical field during the procedure and facilitate vascular dissection. 10 Limitations to the use of ICG are scarce. In patients with abnormal liver function the uptake and especially, the elimination may be altered.…”

“…The use of gray-scale cameras versus others in black and white is recommended, since although both capture ICG fluorescence, the firsts improve the visualization of the surgical field during the procedure and facilitate vascular dissection. 10 …”