Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

Abstract

Background: Indocyanine green (ICG) imaging has been increasingly used for intraoperative guidance in colorectal surgery over the past decade. The aim of this study was to review and organize, according to different type of use, all available literature on ICG guided colorectal surgery and highlight areas in need of further research and discuss future perspectives. Methods: PubMed, Scopus, and Google Scholar databases were searched systematically through November 2022 for all available studies on fluorescence-guided surgery in colorectal surgery. Results: Available studies described ICG use in colorectal surgery for perfusion assessment, ureteral and urethral assessment, lymphatic mapping, and hepatic and peritoneal metastases assessment. Although the level of evidence is low, results are promising, especially in the role of ICG in reducing anastomotic leaks. Conclusions: ICG imaging is a safe and relatively cheap imaging modality in colorectal surgery, especially for perfusion assessment. Work is underway regarding its use in lymphatic mapping, ureter identification, and the assessment of intraperitoneal metastatic disease.

Clinical Utility of Laser Speckle Contrast Imaging and Real-Time Quantification of Bowel Perfusion in Minimally Invasive Left-Sided Colorectal Resections

“…Randomization was not performed in this study, and cohort comparison to the intervention group relied on retrospective case-matching. Although ICG was injected uniformly at T1 and perfusion immediately assessed in 1 to 3 minutes, corresponding with best practices, 29 repeat ICG injections at T2 and T3 were encouraged but ultimately left to surgeon discretion because of variation in surgeon preference of repeated ICG usage and patient safety. Therefore, ICG-FA perfusion assessment at T2 and T3 was not standardized.…”

“…Two milligrams of ICG was injected intravenously and interpreted within 1 to 3 minutes at T1 to enable ICG-FA assessment of the ischemic LOD following published best practices. 29 Repeat ICG injections at T2 and T3 were left to the surgeon discretion.…”

Application of a self-developed, low-budget indocyanine green camera in surgical imaging – a single institution's experiences

“…The method is also useful in other areas of GI surgery: visualization of lymphatic vessels and lymph nodes, identi cation of ureter and urethra, etc. During the search for peritoneal metastases, for example, in 1/3 of the cases, the surgical strategy was changed with the use of ICG [9]. The SENORITA study studied the use of ICG in early gastric cancers.…”

Biotin‐new indocyanine green conjugate: Synthesis, in vitro photocytotoxicity and in vivo biodistribution

“…In addition, ICG has been proposed for breast cancer imaging (Toh et al., 2015). ICG could generate fluorescence, hyperthermia and singlet oxygen upon 808 nm laser irradiation, which allows ICG to be used for molecular imaging and phototherapy in cancer diagnosis and therapeutics (Chen et al., 2016; Hong et al., 2022; Pollmann et al., 2023). Besides, ICG has been widely investigated to combine with other therapeutics such as immunotherapy, chemotherapy and radiotherapy to better suppress cancer (Lian et al., 2023; Lu et al., 2023; Sun et al., 2022; Tu et al., 2020).…”