Key clinical applications for indocyanine green fluorescence imaging in minimally invasive colorectal surgery

Abstract

Near-infrared indocyanine green (ICG) fluorescence imaging has gained solid acceptance over the last years, and rightly so, as this technology has so much to offer, especially in the field of minimally invasive surgery. Firm evidence from ongoing and future studies will hopefully transform many of the applications of ICG fluorescence into the standard of care for our patients. This review examines the current status of ICG fluorescence for assessment of bowel perfusion, lymphatic mapping as well as intraoperative localisation of ureter in light of the published academic literature in English.

Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery

“…They also agreed, with 100% consensus, that both fluorescence imaging and the use of ICG should be considered very safe. Considerable published evidence exists that agrees with this, documenting both the effectiveness and safety of fluorescence technology and ICG across a wide range of settings and disciplines, including several studies each documenting its usefulness detecting tumors and sentinel lymph nodes in patients with breast, 8 – 10 lung, liver, 13 , 14 colon, 15 stomach, 16 and pelvic 17 – 19 cancer; assessing tissue perfusion involving both viscera 13 , 20 – 23 and in plastic surgery 24 – 29 ; identifying anastomotic leaks, particularly during gastrointestinal surgery 13 , 22 , 30 – 32 ; and locating the parathyroid glands during thyroid and parathyroid resections, so as to avoid inadvertent damage or resection and resultant post-operative hypocalcemia. 34 This includes the recent publication of numerous meta-analyses, all of which have demonstrated either superiority of ICG relative to alternatives, or equivalence with advantages such as, cost and ease of use.…”

Robotic versus laparoscopic surgery for colorectal cancer: a case-control study

“…The data source was a prospectively maintained database in a single academic institution with previous history of performing laparoscopic assisted surgeries for many years. 11 , 12 Approval for the study was obtained from the Medical Ethics Committee of the Republic of Slovenia.…”

Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey

“…7e10 Indocyanine green (ICG) is a fluorophore that responds to nearinfrared irradiation, absorbing light between the wavelengths of 790 and 805 nm and re-emitting it with an excitation wavelength of 835 nm. 11 Since the initial use of ICG fluorescence imaging almost 50 years ago via the introduction of applied ophthalmic angiography, 12 its use has expanded exponentially 13 to include the identification of tumors and sentinel lymph nodes involving the breast, 14e16 lungs, 17,18 liver, 19,20 colon, 21,22 stomach, 21e23 and pelvis 24e28 ; the assessment of tissue perfusion in viscera 19,22,29e31 and during plastic surgery 32,33 ; identifying anastomotic leaks 34e36 ; and assessing parathyroid gland vitality during thyroid and parathyroid resections. 37,38 It was approximately 2 decades ago that intraoperative fluorescent imaging made its first foray into endoscopic surgery on the liver and biliary tree.…”