Indocyanine green enhanced surgery; principle, clinical applications and future research directions

Abstract

Over the past decade a new emergent technology has become very popular in all fields of surgery using Indocyanine green and near infrared fluorescent optical systems. This revolutionary approach overlaps conventional and near infrared images to produce highly informative intraoperative images on the anatomy and physiology of various tissues. Near infrared fluorescence is employed for perioperative angiography in vascular mapping, assessment of anastomoses, location of sentinel lymph nodes and delineation of biliary tree anatomy, highlighting tumours and metastatic deposits, improving surgical techniques and for many other uses. A lot of researchers have reported better surgical outcomes and technique innovations facilitated by this novel technology which although in its early stages, it lights up great interest worldwide. This article reviews the principle of the method, the properties of the fluorescent dye, the main clinical applications and discusses future research directions.

Anchoring Microbubbles on Cerebrovascular Endothelium as a New Strategy Enabling Low‐Energy Ultrasound‐Assisted Delivery of Varisized Agents Across Blood‐Brain Barrier

“…First, ICG was selected as a model drug to indicate changes in BBB permeability using in vivo photoacoustic (PA) imaging ( Figure a(i)). [ 35 ] As shown in Figure 5a(iii), the PA signal in the blood vessels of the brain (outlined in Figure 5a(ii)) was enhanced after injecting ICG‐loaded bindable microbubble (ApoER‐Pep‐MB@ICG) into mice via the tail vein. The hemisphere displayed much higher PA intensity at 0.5 h after exposure to DUS than the contralateral hemisphere without irradiation.…”

Tumor Accumulation and Off-Target Biodistribution of an Indocyanine-Green Fluorescent Nanotracer: An Ex Vivo Study on an Orthotopic Murine Model of Breast Cancer

“…ICG is a tricarbocyanine, water-soluble fluorescent dye with substantial fluorescence emission in the near-infrared (NIR) wavelength region (700–900 nm) [ 8 , 12 , 13 , 14 ]. Due to its fluorescent characteristics and safety, ICG is currently used for several cancer-related surgical applications, including sentinel lymph node (SLN) mapping, the identification of solid tumors, lymphography, angiography, and anatomical imaging during surgery [ 14 , 15 , 16 , 17 , 18 ]. However, since it lacks specific tumor targeting and suffers from rapid degradation and blood-stream elimination [ 19 , 20 ], the potential for its use in oncological FGS still has certain limitations [ 3 , 21 , 22 ].…”

Update zur Navigation im OP-Saal

“…Die Fluoreszenzbildgebung ist eine vielversprechende Technologie für die chirurgische Navigation. Sie basiert auf dem Einsatz von exogenen Kontrastmitteln (fluoreszierende Farbstoffe), die bei durch eine bestimmte Wellenlänge Licht emittieren und spezifische Gewebe oder Strukturen hervorheben [31,32,33]. Sie liefert einen hohen Kontrast zwischen den fluoreszierend markierten Strukturen und dem umgebenden Gewebe.…”