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The International Society for Fluorescence Guided Surgery announces publication of consensus on Fluorescence Guided Surgeries (FGS) in Annals of Surgery

November 19, 2020; Fort Lauderdale, FL, USA: The International Society for Fluorescence Guided Surgery (ISFGS), the leading organization dedicated to the global advancement of fluorescence-guided surgery, is pleased to announce the publication in Annals of Surgery, “Consensus Conference Statement on the general use of near-infrared fluorescence imaging and indocyanine green guided surgery: Results of a modified Delphi study”.

“This publication confirms that fluorescence-guided surgeries will dramatically alter the way surgeries will be performed in future”, said lead author Raul J. Rosenthal MD FACS, Clinical Professor of Surgery at the Lerner College of Medicine at CWRU and Department Chairman of General Surgery at Cleveland Clinic in Weston, Florida. “We are delighted that this eminent group of surgeons, came to the consensus that near-infrared-fluorescence-guided surgery is effective and safe across a broad variety of clinical settings and results in safer surgeries with improved outcomes for the patient ”, Dr. Fernando Dip, President of ISFGS continued.

Aided by grant funding from Diagnostic Green, Intuitive Surgical, Medtronic, Olympus, and Stryker, the publication’s findings are supported by 26 leading surgeons and experts in fluorescence-guided surgery, from 23 international institutions across five continents.

Using a Delphi survey approach, the publication was designed to assess current practices with respect to the use of fluorescence imaging, with and without Indocyanine Green (ICG), and to identify areas of consensus amongst an international panel of surgeons.

All surgeons in the study consider the use of fluorescence imaging, with or without ICG, to be both highly effective and very safe across a broad range of clinical fields and settings. All surgeons believed that the use of ICG during fluorescence-guided surgery, with and without ICG, should be part of routine surgical practice. Using fluorescence technology decreases the overall risk of a patient's perioperative care. In general, fluorescence imaging is considered an important tool for the visualization of vital anatomical structures such as arteries and veins as well as the visualization of cancerous lesions, sentinel lymph nodes, and an important tool in tissue perfusion. Over the next decade, the contributors to the publication believe that the role of fluorescence-guided surgery in clinical practice will increase and that it has the potential to dramatically alter the way that many surgical procedures are performed and will significantly enhance patient outcomes.

The publication is available via open access at the following link https://journals.lww.com/annalsofsurgery/Citation/9000/Consensus_Conference_Statement_on_the_General_Use.93976.aspx

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Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery

Background: Indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) has been recently adopted in pediatric minimally invasive surgery (MIS). This study aimed to report our experience with ICG-guided NIRF in pediatric laparoscopy and robotics and evaluate its usefulness and technique of application in different pediatric pathologies. Methods: ICG technology was adopted in 76 laparoscopic and/or robotic procedures accomplished in a single division of pediatric surgery over a 24-month period (January 2018–2020): 40 (37 laparoscopic, three robotic) left varicocelectomies with intra-operative lymphography; 13 (10 laparoscopic, three robotic) renal procedures: seven partial nephrectomies, three nephrectomies, and three renal cyst deroofings; 12 laparoscopic cholecystectomies; five robotic tumor excisions; three laparoscopic abdominal lymphoma excisions; three thoracoscopic procedures: two lobectomies and one lymph node biopsy for suspected lymphoma. The ICG solution was administered into a peripheral vein in all indications except for varicocele and lymphoma in which it was, respectively, injected into the testis body or the target organ. Regarding the timing of the administration, the ICG solution was administered intra-operatively in all indications except for cholecystectomy in which the ICG injection was performed 15–18 h before surgery. Results: No conversions to open or laparoscopy occurred. No adverse and allergic reactions to ICG or other postoperative complications were reported. Conclusions: Based upon our 2 year experience, we believe that ICG-guided NIRF is a very useful tool in pediatric MIS to perform a true imaged-guided surgery, allowing an easier identification of anatomic structures and an easier surgical performance in difficult cases. The most common applications in pediatric surgery include varicocele repair, difficult cholecystectomy, partial nephrectomy, lymphoma, and tumors excision but further indications will be soon discovered. ICG-enhanced fluorescence was technically easy to apply and safe for the patient reporting no adverse reactions to the product. The main limitation is represented by the specific equipment needed to apply ICG-guided NIRF in laparoscopic procedures, that is not available in all centers whereas the ICG system Firefly® is already integrated into the robotic platform.

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Image-guided pediatric patients using indocyanine green (ICG) fluorescence in minimally invasive surgery

Indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) has been recently adopted in pediatric minimally invasive surgery (MIS). This video aimed to report our experience with ICG-guided NIRF in pediatric laparoscopy, thoracoscopy and robotics and evaluate its usefulness and technique of application in different pediatric pathologies.

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