Background: Being able to accurately identify sensory and motor nerves is crucial during surgical procedures to prevent nerve injury. We aimed to (1) evaluate the feasibility of performing peripheral human nerve visualization utilizing nerves' own autofluorescence in an ex-vivo model; (2) compare the effect of three different nerve fiber fixation methods on the intensity of fluorescence, indicated as the intensity ratio; and (3) similarly compare three different excitation ranges.
Background: During surgery, surgeons must accurately localize nerves to avoid injuring them. Recently, we have discovered that nerves fluoresce in near-ultraviolet light (NUV) light. The aims of the current study were to determine the extent to which nerves fluoresce more brightly than background and vascular structures in NUV light, and identify the NUV intensity at which nerves are most distinguishable from other tissues.
Widespread Anorectal lymphovascular networks and tissue drainage: analyses from submucosal India ink injection and indocyanine green fluorescence imaging
Aim Abdominoperineal resection is associated with poor prognosis in patients with advanced lower rectal cancer. This study aimed to analyze the functional lymphovascular network and tissue drainage in the anorectal region.
Does near-infrared fluorescent cholangiography with indocyanine green reduce bile duct injuries and conversions to open surgery during laparoscopic or robotic cholecystectomy?
Abstract Background Bile duct injury and conversion-to-open–surgery rates remain unacceptably high during laparoscopic and robotic cholecystectomy. In a recently published randomized clinical trial, using near-infrared fluorescent cholangiography with indocyanine green intraoperatively markedly enhanced biliary-structure visualization. Our systematic literature review compares bile duct injury and conversion-to-open–surgery rates in patients undergoing laparoscopic or robotic cholecystectomy with versus without near-infrared fluorescent cholangiography.
Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis
Background Anastomotic leakage after a colorectal resection results in devastating consequences for patients. Indocyanine green fluorescence angiography is a modality to visualize vascular perfusion at the anastomotic site and can help surgeons decide the viability of the anastomosis. We performed this systematic review and meta-analysis to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage. Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify studies comparing the use of indocyanine green fluorescence angiography versus standard care on rates of anastomotic leakage. Data were pooled with the Mantel-Haenszel method and analyzed based on a random-effects model to estimate the pooled odds ratio and 95% confidence interval. The heterogeneity of studies was evaluated using I2 statistic. Results Twenty studies were included in this meta-analysis of 5,498 patients. The pooled estimate of the odds ratio …
Commentary on: Indocyanine green does not decrease the need for bail-out operation in an acute care surgery population
The authors of this publication are to be commended for conducting this retrospective study analyzing the impact of near infrared fluorescent cholangiography (NIFC) in patients undergoing laparoscopic cholecystectomy (LC) for symptomatic or complicated cholelithiasis in an acute care setting. In this study, a total of 198 patients who underwent LC were evaluated. Acute cholecystitis was present in 48% of the patients, and NIFC was used in 57% of those. The primary endpoint of the analysis was if using NIFC would decrease the need for a bailout operation in this patient population. The bailout operations were more common in those patients with acute cholecystitis (9%) than those without (2%). The number of bailout operations was 6% in the NIFC group versus 4% in the group with white light alone. The authors conclude that NIFC did not have a significant impact by …
Anastomosis Leak: Is There Still a Place for Indocyanine Green Fluorescence Imaging in Colon-Rectal Surgery? A Retrospective, Propensity Score-Matched Cohort Study
Abstract Anastomotic leakage (AL) represents one of the most relevant complications of colorectal cancer surgery. The aim of this study was to evaluate the utility of intraoperative indocyanine green (ICG) fluorescence imaging in the prevention of AL during laparoscopic colorectal surgery. Methods. We retrospectively analyzed 272 patients who underwent rectal and left colon surgery, consecutively enrolled between 2015 and 2019. Due to the heterogeneity of our groups, a propensity score matching (PSM) was performed with a 1:1 PSM cohort. Results. AL occurred in 36 (13.2%) patients. One hundred seventy-seven (65%) of them underwent an intraoperatory ICG test (ICG-group), whereas 95 patients (35%) did not receive the intraoperatory ICG test (no-ICG group). AL occurred in 10.8% of ICG group patients and in 17.8% of no-ICG group patients (P = 0.07). The ICG group registered significantly less type B and type C …
Artificial intelligence indocyanine green (ICG) perfusion for colorectal cancer intra-operative tissue classification
Surgery has a substantial role in the therapy of over two-thirds of cancers. Perfect realization of all disease at the time of surgery would improve its efficiency and effectiveness1,2. Fluorescence guidance aims to allow an observer to characterize tissues visually by utilizing near-infrared (NIR) light from an administered fluorophore3,4. Most commonly, intraoperative indocyanine green (ICG) is used to assess intestinal perfusion around anastomotic construction5, and is also known to stain cancer tissue non-specifically6,7. Agents with greater cancer cell selectively, most often fluorophore antibody conjugates8, are in development but are limited by peroperative scheduling issues and intraoperative false-positive rates9–12. The processes for uptake and release of exogenous substances (such as drugs and contrast agents) are fundamentally distinctive in malignant tissues. As such, it was envisaged that an approach combining biophysics-inspired modelling and artificial intelligence (AI) could analyse intraoperative changes in NIR …
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 …
Consensus Conference Statement on the General Use of Near-Infrared Fluorescence Imaging and Indocyanine Green Guided Surgery Results of a Modified Delphi Study
In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and non- consensus across 4 areas of practice: fundamentals; patient selection/ preparation; technical aspects; and effectiveness and safety.