Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green

Figure 1 The utility of indocyanine green dye in oesopgago-gastric anastomosis planning. A: The line of demarcation of indocyanine green (ICG (blue line) at the tip of gastric conduit (red line) to assess perfusion in a patient; B: The prepared gastric conduit with the tip of conduit with poor blood supply, as determined by ICG marked with blue marking line.

Figure 2 A 84-year-old patient with imaging showing 7 cm hepatocellular carcinoma was scheduled for elective laparoscopic right posterior sectionectomy. Indocyanine green dye was injected 10 d before the surgery date. A: Cirrhotic liver with a new liver lesion detected by positive indocyanine green (ICG) staining; B: Excision of this nodule with adequate margins as guided by ICG. Postoperative histology confirmed the new nodule to be primary hepatocellular carcinoma. ICG: Indocyanine green.

Figure 3 A 60-year-old patient undergoing elective liver cyst deroofing for a symptomatic solitary benign epithelial liver cyst was injected with 7 mL of indocyanine green dye after insertion of camera port. A: Liver enhancement at 10 min; B: After 20 min of injection shows the dye enhances the liver and cyst wall remains unenhanced; C: How indocyanine green (ICG) guidance can avoid transecting the liver parenchyma during cyst wall excision; D: The cyst wall with positive ICG staining is excised using stapling technology to reduce bile leak risk. ICG: Indocyanine green.

Figure 4 A 50-year-old patient undergoing elective laparoscopic cholecystectomy for previous acute cholecystitis was injected with 4 mL of indocyanine green dye after insertion of camera port. A: Rouvier’s sulcus and corresponding; B: After 15 min of injection shows the dye enhances the liver (blue arrow) and indocyanine green (ICG) is yet to be excreted in biliary tree; C: Calot’s triangle with a critical view of safety and clipped cystic artery; D: At 40 min after ICG injection shows beginning of biliary excretion in cystic duct and common bile duct. ICG: Indocyanine green.

Figure 5 The utility of indocyanine green dye in laparoscopic anterior resection. A: The descending colon prepared for proximal transection during laparoscopic anterior resection, with the purple line indicating intended transection site, 5 cm proximal to tumour; B: The indocyanine green angiography confirms good vascularity at the site of intended transection, prior to creation of colo-rectal anastomosis.