Clinical application and technical standardization of indocyanine green (ICG) fluorescence imaging in pediatric minimally invasive surgery

Esposito, Ciro; Conte, Fulvia Del; Cerulo, Mariapina; Gargiulo, Francesco; Izzo, Serena; Esposito, Giovanni; Spagnuolo, Maria Immacolata; Escolino, Maria

doi:10.1007/s00383-019-04519-9

Cited by 54 publications

(49 citation statements)

References 31 publications

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“…An important number of included studies ( n = 37; 58%) were at high risk of selection bias as none of them were randomized and allocation of intervention was based on the surgeon's choice. Data collection was mentioned as prospective in only 13/64 studies ( 14 , 22 , 31 , 34 , 44 ). While outcomes were generally appropriate for the study aim, 80% of included studies were at high or unclear risk of information biases either because outcomes were not objectively assessed or blinding of surgeons to the intervention was not possible.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Purpose: Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging technique used to assess tissue vascularization and guide intraoperative decisions in many surgical fields including plastic surgery, neurosurgery, and general surgery. While this technology is well-established in adult surgery, it remains sparsely used in pediatric surgery. Our aim was to systematically review and provide an overview of all available evidence on the perioperative use of indocyanine green fluorescence angiography in pediatric surgical patients.Methods: We conducted a systematic review with narrative synthesis in conformity with the PRISMA guidelines using PubMed, Medline, All EBM Reviews, EMBASE, PsycINFO, and CINAHL COMPLETE databases to identify articles describing the perioperative use of ICG-FA in pediatric patients. Two independent authors screened all included articles for eligibility and inclusion criteria. We extracted data on study design, demographics, surgical indications, indocyanine green dose, and perioperative outcomes. We developed a risk of bias assessment tool to evaluate the methodological quality of included studies.Results: Of 1,031 articles retrieved, a total of 64 articles published between 2003 and 2020 were included reporting on 664 pediatric patients. Most articles were case reports and case series (n = 36; 56%). No adverse events related to ICG-FA were reported in the included articles. Risk of bias was high. We did not conduct a meta-analysis given the heterogeneous nature of the populations, interventions, and outcome measures. A narrative synthesis is presented.Conclusion: Indocyanine green fluorescence angiography is a safe imaging technology and its use is increasing rapidly in pediatric surgical specialties. However, the quality of evidence supporting this trend currently appears low. Case-control and randomized trials are needed to determine the adequate pediatric dose and to confirm the potential benefits of ICG-FA in pediatric surgical patients.Systematic Review Registration: This study was registered on Prospero a priori, identifier: CRD42020151981.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…As recently published [17][18][19][20], the incorporation of ICG fluorescent cholangiography (FC) into LC has the potential to provide real-time visualization of the extrahepatic biliary tree prior to commencing dissection within the Calot's triangle. The evolving technologies have recently provided the surgeons perfect camera systems to achieve even better intra-operative visualization.…”

Section: Discussionmentioning

confidence: 99%

“…Once reconstituted, the ICG solution was injected via the intravenous route using a dosage of 0.35 mg/Kg. The median timing of administration was 15.6 h prior to surgery (range [8][9][10][11][12][13][14][15][16][17][18][19][20]. Following the administration, patients were monitored for any signs of allergic reaction to the dye.…”

Section: Operative Techniquementioning

confidence: 99%

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Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

et al. 2021

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Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Fluorescence Imaging Using Indocyanine Green Dye in the Pediatric Population

Shafy¹,

Hakim²,

Lynch³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Fluorescence imaging using indocyanine green (ICG) allows for the intraoperative mapping of the vascular supply of various tissue beds. Although generally safe and effective, rare adverse effects have been reported including anaphylactoid reactions. The current study retrospectively reviewed our experience the intraoperative administration of ICG to pediatric patients. METHODS The anesthetic records of patients who received ICG over a 2-year time period were retrospectively reviewed and demographic, surgical, and medication data retrieved. Objective intraoperative data before and after the administration of ICG were also recorded. These included heart rate, systolic and diastolic blood pressures, oxygen saturation, and peak inflating pressure. RESULTS The study cohort included 100 patients with a median age of 12 years (9.5 ± 7.4 years) and the median weight being 44.5 kg (45.9 ± 36.9 kg). ICG was administered intravenously to all patients. In all cases, 2.5 mg/mL ICG solution was used, with a median dose of 1.1 mL (1.79 ± 1.8 mL). Eight patients received more than 1 dose of ICG, with no adverse respiratory or hemodynamic effects related to its use. CONCLUSIONS ICG fluorescence is an important imaging modality that can be safely used as an intraoperative adjunct to various surgical procedures in the pediatric population.

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Clinical application and technical standardization of indocyanine green (ICG) fluorescence imaging in pediatric minimally invasive surgery

Cited by 54 publications

References 31 publications

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

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

Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

Fluorescence Imaging Using Indocyanine Green Dye in the Pediatric Population

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