SPECIAL CONSIDERATIONS
- ALWAYS dilute with sterile water
- ALWAYS flush with sterile water
- Max dose is 2 mg/kg (e.g.: 120 mg or 4.8 reconstituted flasks of 25 mg/mL of ICG)
- *For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
DISCLAIMERS
- Doses are device-dependent
- The above dosage and timing information have been collated from worldwide surgeons expert in these procedures and is based on their recommendations and is not evidence-based.
- All dosages have been adjusted to the U.S. recommended dilution of 25mg of ICG in 10mL of sterile water
- Approval for listed indications may vary according to country.
Cholecystectomy
Purpose: Bile duct visualization
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 to 2 mL
Injection Time: Recommended: At least 45 minutes before procedure
First Indocyanine Green Detection: After Calot triangle is exposed
Indocyanine Green Duration: Visible during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform reflux maneuver to enhance visualization of cystic duct.
Colorectal Resection
Purpose: Perfusion assessment
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 3 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minuites
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform tissue vitality assessment as necessary prior to resection. Repeat assessment after anastomosis.
Liver Segmentation
Purpose: Visualize liver segments
Injection Type: Other
Description: Positive staining technique: inject directly into the portal branch.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.1 mL*
Injection Time: Prior to hepatic dissection
First Indocyanine Green Detection: Several seconds after administration
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Positive staining should be performed under ultrasound-guided portal branch puncture.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
Liver Segmentation
Purpose: Visualize liver segments
Injection Type: Intravenous
Description: Negative staining technique: Administer via peripheral intravenous access
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: After portal pedicle closure
First Indocyanine Green Detection: Several seconds after administration
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Clamp liver segment at the time of assessment.
Liver Cancer
Purpose: Visualization of primary & metastatic liver tumors
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 0.5 mg/kg
Injection Time: 7 days preoperatively
First Indocyanine Green Detection: Real time during hepatectomy
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Hepatocellular carcinoma shows cancerous fluorescence signals. Metastatic tumors show rim fluorescence signals.
Esophagectomy
Purpose: Perfusion assessment
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 3 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: 30–60 secnds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform tissue vitality assessment, as necessary, prior to resection. Repeat assessment after anastomosis.
Ureter Localization
Purpose: Visualization of ureters
Injection Type: Other
Description: Cystoscopy guidance is recommended for retrograde intraureteral dye administration.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 5 mL per ureter
Injection Time: Prior to pelvic dissection
First Indocyanine Green Detection: During pelvic dissecction
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Advance ureteral catheter to ensure comprehensive assessment of the ureteral course.
Thyroidectomy
Purpose: Visualization of parathyroid glands
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: After thyroid gland dissection
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Check perfusion of parathyroid glands at the time of assessment.
Thyroidectomy
Purpose: Guided dissection during thyroid gland exposure
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: During thyroid gland dissection
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Check vasculature surrounding gland during superior pole dissection.
Lymphedema
Purpose: Lymph vessel assessment
Injection Type: Other
Description: Administration should be subcutaneous into bilateral interdigit hand or foot.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.1 mL*
Injection Time: At time of lymph vessel evaluation
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Hours
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Gentle, circular motion massaging can be performed to distribute dye.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
Cervical/Endometrial Cancer
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Administration of the dye should be performed at the level of the cervical submucosa, deep into the stroma. The dye should be distributed into 4 cervical quadrants.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: Prior to dissection & insertion of uterine manipulator
First Indocyanine Green Detection: At start of procedure
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Total 4 mL (1 mL per cervical quadrant).
Vulvar cancer
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Peritumoral
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: At start of procedure.
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Total 4 mL (1 mL per tumor quadrant borders).
Breast cancer
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Dye administration should be subcutaneous into periareolar region of each quadrant.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: At start of procedure.
First Indocyanine Green Detection: Five to 10 minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Total 4 mL (1 mL per periareolar quadrant). Gentle, circular motion massaging can be performed to distribute dye.
Breast reconstruction
Purpose: Mastectomy skin flaps perfusion
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: During skin flap manipulation and reconstruction.
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 s–3 mins
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Adjunct to clinical assessment and surgical symmetry.
Colorectal & Gastrointestinal Carcinoma
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Administration should be peritumoral.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Intramural tumor: Intraoperative administration avoiding too much depth into the mucosa. Gastric lymphatics mapping: consider endoscopic peritumoral dye administration 24 hrs prior to lymphadenectomy.
Melanoma
Purpose: Sentinel lymph node identification
Injection Type: Other
Description: Administration should be intradermal, surrounding the area of interest.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.2 mL*
Injection Time: Five min prior to manipulation of skin site.
First Indocyanine Green Detection: Five to 10 minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Dye administration should be performed prior to local anesthesia administration.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
Purpose: Bile duct visualization
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 to 2 mL
Injection Time: Recommended: At least 45 minutes before procedure
First Indocyanine Green Detection: After Calot triangle is exposed
Indocyanine Green Duration: Visible during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform reflux maneuver to enhance visualization of cystic duct.
Purpose: Perfusion assessment
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 3 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minuites
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform tissue vitality assessment as necessary prior to resection. Repeat assessment after anastomosis.
Purpose: Visualize liver segments
Injection Type: Other
Description: Positive staining technique: inject directly into the portal branch.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.1 mL*
Injection Time: Prior to hepatic dissection
First Indocyanine Green Detection: Several seconds after administration
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Positive staining should be performed under ultrasound-guided portal branch puncture.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
Purpose: Visualize liver segments
Injection Type: Intravenous
Description: Negative staining technique: Administer via peripheral intravenous access
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: After portal pedicle closure
First Indocyanine Green Detection: Several seconds after administration
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Clamp liver segment at the time of assessment.
Purpose: Visualization of primary & metastatic liver tumors
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 0.5 mg/kg
Injection Time: 7 days preoperatively
First Indocyanine Green Detection: Real time during hepatectomy
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Hepatocellular carcinoma shows cancerous fluorescence signals. Metastatic tumors show rim fluorescence signals.
Purpose: Perfusion assessment
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 3 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: 30–60 secnds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Perform tissue vitality assessment, as necessary, prior to resection. Repeat assessment after anastomosis.
Purpose: Visualization of ureters
Injection Type: Other
Description: Cystoscopy guidance is recommended for retrograde intraureteral dye administration.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 5 mL per ureter
Injection Time: Prior to pelvic dissection
First Indocyanine Green Detection: During pelvic dissecction
Indocyanine Green Duration: Remains stable during surgery
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Advance ureteral catheter to ensure comprehensive assessment of the ureteral course.
Purpose: Visualization of parathyroid glands
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: After thyroid gland dissection
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Check perfusion of parathyroid glands at the time of assessment.
Purpose: Guided dissection during thyroid gland exposure
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: During thyroid gland dissection
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 seconds–3 minutes
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Check vasculature surrounding gland during superior pole dissection.
Purpose: Lymph vessel assessment
Injection Type: Other
Description: Administration should be subcutaneous into bilateral interdigit hand or foot.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.1 mL*
Injection Time: At time of lymph vessel evaluation
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Hours
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Gentle, circular motion massaging can be performed to distribute dye.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Administration of the dye should be performed at the level of the cervical submucosa, deep into the stroma. The dye should be distributed into 4 cervical quadrants.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: Prior to dissection & insertion of uterine manipulator
First Indocyanine Green Detection: At start of procedure
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Total 4 mL (1 mL per cervical quadrant).
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Peritumoral
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: At start of procedure.
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Total 4 mL (1 mL per tumor quadrant borders).
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Dye administration should be subcutaneous into periareolar region of each quadrant.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: At start of procedure.
First Indocyanine Green Detection: Five to 10 minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Total 4 mL (1 mL per periareolar quadrant). Gentle, circular motion massaging can be performed to distribute dye.
Purpose: Mastectomy skin flaps perfusion
Injection Type: Intravenous
Description: -
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: Yes
Proposed Dosage: 1 mL
Injection Time: During skin flap manipulation and reconstruction.
First Indocyanine Green Detection: 30–60 seconds after administration
Indocyanine Green Duration: 60 s–3 mins
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Adjunct to clinical assessment and surgical symmetry.
Purpose: Visualize lymphatic drainage & sentinel lymph node
Injection Type: Other
Description: Administration should be peritumoral.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 1 mL
Injection Time: Intraoperatively
First Indocyanine Green Detection: Minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Both
Tips & Tricks: Intramural tumor: Intraoperative administration avoiding too much depth into the mucosa. Gastric lymphatics mapping: consider endoscopic peritumoral dye administration 24 hrs prior to lymphadenectomy.
Purpose: Sentinel lymph node identification
Injection Type: Other
Description: Administration should be intradermal, surrounding the area of interest.
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL): Yes
Requires Flush with Sterile Water: No
Proposed Dosage: 0.2 mL*
Injection Time: Five min prior to manipulation of skin site.
First Indocyanine Green Detection: Five to 10 minutes after administration
Indocyanine Green Duration: Stable during surgery. Slowly diffuses through lymphatics
Camera Requirements (handheld device, laparoscope or both): Handheld
Tips & Tricks: Dye administration should be performed prior to local anesthesia administration.
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
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