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

Abstract

Background:In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed.Objective:In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety.Methods:A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively.Results:Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus.Conclusions:Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.

ICG-Guided Lymphadenectomy during Surgery for Colon and Rectal Cancer—Interim Analysis of the GREENLIGHT Trial

“…In recent years, several strategies have been investigated aimed at intraoperatively visualizing the single-patient lymphatics' anatomy for surgical guidance. Indocyanine-green (ICG) is a fluorescent fluorophore that over the past decades has been tested and used across an ever-expanding range of clinical setting [15][16][17]. In particular, ICG, which after direct tissue injection migrates in lymphatics and lymph nodes providing an intraoperative map of the tumor-specific draining area [18], is emerging as the preferred modality for lymphatic mapping in colon and rectal cancer.…”

Perfusion Visualization during Ileal J-Pouch Formation—A Proposal for the Standardization of Intraoperative Imaging with Indocyanine Green Near-Infrared Fluorescence and a Postoperative Follow-Up in IBD Surgery

“…In several recent reviews on fluorescence-guided abdominal surgery, a lack of quantitative, unbiased data in the available literature and the need for further research into the specifics of its application were pointed out [ 24 , 30 , 31 , 32 ]. The authors of these reviews remarked that the reported approaches of vascular perfusion assessment with ICG do not take into account the accumulation of ICG over time.…”

Novel Multimodal, Multiscale Imaging System with Augmented Reality

“…Surgical setting often needs different scale to accommodate various imaging application, such as tissue perfusion test and tumor margin assessment [ 12 , 13 , 68 ]. Fluorescence imaging at different scales hold great promise for solving many clinical problems [ 69 ].…”