Fransvea P, Chiarello MM, Fico V, Cariati M, Brisinda G. Indocyanine green: The guide to safer and more effective surgery. World J Gastrointest Surg 2024; 16(3): 641-649 [PMID: 38577071 DOI: 10.4240/wjgs.v16.i3.641]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Professor, Surgeon, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, No. 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
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. Mar 27, 2024; 16(3): 641-649 Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.641
Indocyanine green: The guide to safer and more effective surgery
Pietro Fransvea, Maria Michela Chiarello, Valeria Fico, Maria Cariati, Giuseppe Brisinda
Pietro Fransvea, Valeria Fico, Giuseppe Brisinda, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Maria Cariati, Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Crotone 88900, Italy
Giuseppe Brisinda, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Author contributions: Fransvea P, Chiarello MM and Brisinda G designed the research; Fransvea P and Cariati M performed the research; Fransvea P and Fico V analyzed the data; all the authors wrote and approved the final manuscript.
Conflict-of-interest statement: The authors declare no competing interests.
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: Giuseppe Brisinda, MD, Professor, Surgeon, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, No. 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Received: December 19, 2023 Peer-review started: December 19, 2023 First decision: January 15, 2024 Revised: January 15, 2024 Accepted: February 8, 2024 Article in press: February 8, 2024 Published online: March 27, 2024 Processing time: 94 Days and 2.5 Hours
Abstract
In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery. The authors present an interesting review on the use of indocyanine green fluorescence in different aspects of abdominal surgery. They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery. Indocyanine green, used for fluorescence imaging, has been approved by the Food and Drug Administration and is safe for use in humans. It can be administered intravenously or intra-arterially. Since its advent, there have been several advancements in the applications of indocyanine green, especially in the surgical field, such as intraoperative mapping and biopsy of sentinel lymph node, measurement of hepatic function prior to resection, in neurosurgical cases to detect vascular anomalies, in cardiovascular cases for patency and assessment of vascular abnormalities, in predicting healing following amputations, in helping visualization of hepatobiliary anatomy and blood vessels, in reconstructive surgery, to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns. For these reasons, the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery. Colorectal surgery has just lately begun to adopt this technique, particularly for perfusion visualization to prevent anastomotic leakage. The regular use of indocyanine green coupled with fluorescence angiography has recently been proposed as a feasible tool to help improve patient outcomes. Using the best available data, it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak. The use of indocyanine green is proven to be safe, feasible, and effective in both elective and emergency scenarios. However, additional robust evidence from larger-scale, high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.
Core Tip: Indocyanine green is a sterile, anionic, water-soluble molecule, which was approved for clinical use in 1959 by the Food and Drug Administration. After intravenous injection, indocyanine green rapidly bounds to plasma lipoproteins. When injected outside blood vessels (e.g., into the normal tissue close to tumors), indocyanine green binds to proteins, reaching the nearest lymph node usually within 15 min. The intraoperative usage of indocyanine green has become common in a variety of surgical specialties and transplant surgery. By observing the signal using a fluorescence imaging video system, surgeons can visualize and assess organ perfusion intraoperatively while making adjustments in real-time.
