Indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: State of the art and future directions

Abstract

In recent years, the use of fluorescence-guided surgery (FGS) to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. FGS relies on the fluorescence signal emitted by injected substances (fluorophores) after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green (ICG)-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The analysis, findings, and discussion presented here rely on the authors’ significant experience with this technique in their medical institutions, an up-to-date review of the most relevant articles published on this topic between 2014 and 2018, and lengthy discussions with key opinion leaders in the field during recent conferences and congresses. For each application, the benefits and limitations of this technique, as well as applicable future directions, are described. The imaging of fluorescence emitted by ICG is a simple, fast, relatively inexpensive, and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future. Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.

Fluorescence guided intraluminal endoscopy in the gastrointestinal tract: A systematic review

“…In this systematic review, we identified seven studies using fluorescence endoscopy to assess and evaluate tumor invasion, detect neoplasms, adenomas and esophageal varices. Although fluorescence endoscopy was first described many years ago, this method with interesting results has become even more promising for therapeutic and diagnostic purposes with the recent advances within the field of fluorescence-guided surgery and cancer-specific imaging[ 26 ].…”

Indocyanine Green Fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review.

“…It is a low-cost molecule, easy to use, widely available and with negligible toxicity [19]. The use of ICG uorescence in abdominal surgery has been introduced in recent years and represents a common tool for perfusion evaluation, extrahepatic bile duct anatomy, lymph node navigation and liver surgery [20][21][22]. ICG binds primarily to serum albumin and other serum globulins such as alpha1-lipoprotein, and then it circulates behaving like a macromolecule [23].…”

Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview

“…Following intravenous administration of the ICG dye, the concentration of the dye will fall exponentially. Measurements of ICU clearance are performed in serial blood samples but can also be determined noninvasively, through pulse dye densitometry using an optical sensor placed at the fingertip [37, 38]. The use of this technology was found to be the best discriminating preoperative test for evaluating hepatic functional reserve in patients diagnosed with HCC [36].…”