ICG in GI Surgery (1)
ICG Uses in Gastrointestinal Surgery
Overview
Indocyanine green (ICG) has emerged as a versatile tool in gastrointestinal surgery, with applications ranging from anatomical identification to perfusion assessment. This summary highlights the key uses of ICG in various gastrointestinal procedures, based on recent research and expert recommendations.
Applications in Gastrointestinal Surgery
1. Anatomical Identification and Mapping
ICG is used for anatomical identification of structures and biliary mapping ([1]).
In laparoscopic cholecystectomy, ICG fluorescence-guided surgery is strongly recommended for biliary tree visualization ([10]).
2. Lymph Node Assessment
ICG aids in sentinel lymph node detection and lymph flow mapping in various gastrointestinal cancers ([2]).
In gastric cancer surgery, ICG-guided lymph node dissection is associated with increased lymph node retrieval and reduced intraoperative blood loss ([15]).
3. Perfusion Assessment
ICG fluorescence angiography is used to evaluate bowel vascularity and anastomotic perfusion ([3]).
In colorectal surgery, ICG use for perfusion assessment is strongly recommended to prevent anastomotic leakage ([10]).
4. Tumor Localization and Margin Assessment
ICG is utilized for primary tumor and metastases localization in gastrointestinal cancers ([2]).
It aids in determining oncological margins and has potential in tumor marker conjugation ([1]).
5. Anastomosis Evaluation
ICG fluorescence angiography is used to assess anastomotic blood flow and predict patient outcomes ([11]).
In rectal cancer surgery, ICG use significantly reduced the incidence of anastomotic leakage ([17]).
6. Esophageal Surgery
ICG is used to assess anastomotic perfusion, lymphatic drainage, and tracheal blood flow after mediastinal dissection in esophagectomy ([16]).
ICG fluorescence angiography during esophagectomy is associated with reduced anastomotic leakage and graft necrosis ([18]).
7. Robotic Surgery
In robotic gastrectomy for gastric cancer, ICG guidance improved lymphadenectomy outcomes compared to conventional laparoscopy ([13]).
ICG has applications in assessing organ vascularization, tissue perfusion, and lymphatic drainage in robotic abdominal surgery ([20]).
8. Pediatric Gastrointestinal Surgery
ICG is used in esophagogastric, intestinal, pancreatic, and colorectal surgeries in children ([5]).
In pediatric procedures, ICG is useful for anastomotic blood flow evaluation and intraoperative determination of resection length ([8]).
9. Emergency Abdominal Surgery
ICG has potential applications in preventing undue intestinal resections, detecting intestinal ischemic zones, and identifying biliary tree anatomy in acute situations ([7]).
Conclusion
The use of ICG in gastrointestinal surgery has shown significant benefits across various procedures. Strong evidence supports its use in perfusion assessment, lymph node mapping, and anatomical identification. ICG fluorescence-guided surgery has demonstrated improved outcomes in colorectal, gastric, and esophageal surgeries. While more research is needed in some areas, such as emergency abdominal surgery and pediatric applications, the overall trend suggests that ICG is becoming an increasingly valuable tool in gastrointestinal surgical practice.