Indocyanine Green Fluorescence Imaging in Robotic Surgery: State of Art, Tips and Tricks in Current Applications

Abstract

BACKGROUND: Fluorescent imaging with indocyanine green is an emerging technology whose benefits are put in perspective. OBJECTIVE: This article reports essential principles and approaches of intraoperative fluorescence in general surgery bringing familiarity to its practical usage. Our group describes possible pitfalls and provides tips and tricks for training surgeons making their attempts easier and reproducible during practice. METHODS: This study overviews the most structured concepts, practical applications and its tricks in robotic fluorescence guided imaging surgery with indocyanine green. Possible pitfalls are emphasized and emerging fields of application are put in a perspective. RESULTS: Guided information and practical applications in several surgical fields are described for a safe and reproducible indocyanine green fluorescence imaging use. CONCLUSION: Robotic assisted surgery combined to fluorescence imaging technology represents a logical evolution in image guided surgery and technology familiarity with guided information may represent a wider and safer spectrum of use in surgeons’ hands.

Consensus Statement on the Use of Near-Infrared Fluorescence Imaging during Pancreatic Cancer Surgery Based on a Delphi Study: Surgeons’ Perspectives on Current Use and Future Recommendations

“…ICG has been investigated extensively for FGS, and its safety and effectiveness have been demonstrated in multiple publications [14,[19][20][21][22]. This is mirrored in our survey's findings, which included consensus that ICG is safe and should not be presented as experimental.…”

“…This adds to the argument that, despite numerous efforts, investigators have not yet proven that FGS has any significant advantage over current methods. Fortunately, Module III (Table 4) highlights the perceived benefits and drawbacks of FGS, the majority of which have already been widely discussed [14,15,[19][20][21][22], indicating growing belief in FGS.…”

The role of ICG-fuorescence imaging in abdominal surgical oncology

“…При использовании ICG-флуоресцентной визуализации при вмешательствах на печени необходимо учитывать определенные аспекты. Флуоресценция ткани печени достигается либо при внутривенном введении препарата через периферический или центральный венозный доступ, либо при локальной инъекции в воротную вену интраоперационно в расчете концентрации 0,25 мг/кг [33]. В случае периферического или центрального венозного введения раствора индоцианина зеленого флуоресценция ткани печени возникает через 5 мин; при локальном введении -в течение 1-2 мин.…”

Indocyanine Green-Enhanced Fluorescence-Guided Surgery: Lymphatic Navigation, Perfusion Evaluation and Future Perspectives

“…The fluorescent emitted light passes through a sensor in the optical device, displaying the green light in real-time visualization. Firefly is da Vinci's integrated fluorescence capability that uses near-infrared technology activated at the surgeon's console [9].…”