Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1841
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
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.
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.