Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1841-1857
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1841
Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green
Zavier Yongxuan Lim, Swetha Mohan, Sunder Balasubramaniam, Saleem Ahmed, Caroline Ching Hsia Siew, Vishal G Shelat
Zavier Yongxuan Lim, Swetha Mohan, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Sunder Balasubramaniam, Saleem Ahmed, Caroline Ching Hsia Siew, Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Shelat VG contributed to the conceptualization, supervision and project administration of the manuscript; Lim ZY involved in the methodology of this study; Lim ZY and Mohan S curated data; Lim ZY, Mohan S, Balasubramaniam S, Ahmed S, Siew CCH, and Shelat VG wrote 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: Zavier Yongxuan Lim, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore. zavi0002@e.ntu.edu.sg
Received: May 14, 2023
Peer-review started: May 14, 2023
First decision: July 4, 2023
Revised: July 17, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: September 27, 2023
Processing time: 131 Days and 3.5 Hours
Abstract

Indocyanine green (ICG) is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery. ICG facilitates anatomical identification of structures (e.g., ureters), assessment of lymph nodes, biliary mapping, organ perfusion and anastomosis assessment, and aids in determining the adequacy of oncological margins. In addition, ICG can be conjugated to artificially created antibodies for tumour markers, such as carcinoembryonic antigen for colorectal, breast, lung, and gastric cancer, prostate-specific antigen for prostate cancer, and cancer antigen 125 for ovarian cancer. Although ICG has shown promising results, the optimization of patient factors, dye factors, equipment, and the method of assessing fluorescence intensity could further enhance its utility. This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies. With the emergence of robotic technology and the increasing reporting of ICG utility, a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.

Keywords: Fluorescence imaging; Gastrointestinal surgery; Indocyanine green

Core Tip: Indocyanine green (ICG) is a safe and widely-used fluorescent dye for anatomy delineation, tumour identification and lymph node mapping. ICG has demonstrated superior results in organ perfusion and anastomosis assessment. However, there is still room for further optimization of patient factors, dye factors, and fluorescence intensity assessment. Other dyes, such as ZW-800 and VM678, have shown better pharmacokinetic properties and target-to-background ratios in animal studies, and novel contrast agents that target unique pathology, such as conjugating ICG to artificially created antibodies, are being developed for disease detection and management.