ICG applications in hepatobiliary system: of fluorescence, frontiers and false positives

Abstract

Fluorescence-guided surgery (FGS) is revolutionizing current standards of practice, w indispensable possibilities. Its use in hepatobiliary system has long been existent, but clinical applications have just been recently accepted & broadly utilized. This paper aims to strengthen data on FGS using Indocyanine Green (ICG) in hepatobiliary system - decreasing morbidities & providing real-time intraoperative assessment. Second, of frontiers, in laparoscopic cholecystectomy, liver resection of tumors & liver trauma - the preoperative & intra-operative techniques involved. Also, to present an index case of ICG use for a liver abscess, which to the primary author's knowledge, none has been reported yet. Third, false positive lesions were also reported. 38 cholecystectomies, 4 liver resections & 1 exploration secondary to trauma were performed under laparoscopic FGS. Equipment: KARL STORZ ICG system. ICG was administered at different dosages & timing, depending on the planned surgery. Hepatobiliary structures, pathologies & false positive lesions identified. For liver resection, ICG demarcation of transection corresponded w/ that of the intraoperative ultrasound. No adverse reactions observed. Operative time, not significantly affected. Dosage & timing of ICG administration and integrity of hepatobiliary system are significant in the outcomes of fluorescence-guided surgery. Non-specific nature of ICG-plasma protein binding & hepatic excretion of ICG leads to observance of false-positive lesions. It's one of the few fluorescence imaging techniques for cancer that has reached clinical application. With continuous studies, dynamic innovations & finding solutions for its limitations, FGS might become a standard of practice in the future for hepatobiliary surgery.