Kalayarasan R, Chandrasekar M, Sai Krishna P, Shanmugam D. Indocyanine green fluorescence in gastrointestinal surgery: Appraisal of current evidence. World J Gastrointest Surg 2023; 15(12): 2693-2708 [PMID: 38222003 DOI: 10.4240/wjgs.v15.i12.2693]
Corresponding Author of This Article
Raja Kalayarasan, FRCS (Ed), MBBS, MCh, MS, Additional Professor, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari nagar, Puducherry 605006, India. kalayarasanraja@yahoo.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2693-2708 Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2693
Indocyanine green fluorescence in gastrointestinal surgery: Appraisal of current evidence
Raja Kalayarasan, Murugesan Chandrasekar, Pothugunta Sai Krishna, Dasarathan Shanmugam
Raja Kalayarasan, Murugesan Chandrasekar, Pothugunta Sai Krishna, Dasarathan Shanmugam, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Kalayarasan R and Chandrasekar M conceptualized the work, supervised the writing, gave intellectual inputs, and critically revised the manuscript; Sai Krishna P and Shanmugam D did the literature search and wrote the first draft of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raja Kalayarasan, FRCS (Ed), MBBS, MCh, MS, Additional Professor, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari nagar, Puducherry 605006, India. kalayarasanraja@yahoo.com
Received: July 19, 2023 Peer-review started: July 19, 2023 First decision: October 9, 2023 Revised: October 12, 2023 Accepted: November 9, 2023 Article in press: November 9, 2023 Published online: December 27, 2023 Processing time: 160 Days and 18.3 Hours
Abstract
Applying indocyanine green (ICG) fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines. The research in this field is nascent and fragmented, necessitating academic efforts to gain a comprehensive understanding. The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery. The relevant articles were selected by using the appropriate keyword search in PubMed. The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders. In gastroesophageal and colorectal surgery, the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy. The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion. The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery. Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors. The narrative review outlines prior contributions, limitations, and research opportunities for future studies across gastrointestinal sub-specialty. The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
Core Tip: Indocyanine green (ICG)’s unique absorption and emission spectrum allows its wide application in gastrointestinal surgery. The fluorescence cholangiography property of ICG is widely used in hepatobiliary surgery to identify bile ducts. Its angiography property is used in liver surgery for tumor identification and to facilitate anatomic liver resection. Also, the angiography function is helpful in luminal surgeries to assess bowel perfusion. The limitations of ICG fluorescence highlighted in the present review could guide future research on ICG in gastrointestinal surgery.
