Use Of Indocyanine Green Fluorescence Imaging Research Articles

Intraoperative assessment of anastomotic blood supply using indocyanine green fluorescence imaging following esophagojejunostomy or esophagogastrostomy for gastric cancer.

This retrospective study aimed to evaluate the feasibility and safety of intraoperative assessment of anastomotic blood supply in patients undergoing esophagojejunostomy or esophagogastrostomy for gastric cancer using Indocyanine Green Fluorescence Imaging (IGFI). From January 2019 to October 2021, we conducted a retrospective analysis of patients who had undergone laparoscopic gastrectomy for the treatment of gastric cancer. The patients were consecutively enrolled and categorized into two study groups: the Indocyanine Green Fluorescence Imaging (IGFI) group consisting of 86 patients, and the control group comprising 92 patients. In the IGFI group, intravenous administration of Indocyanine Green (ICG) was performed, and we utilized a fluorescence camera system to assess anastomotic blood supply both before and after the anastomosis. The demographic characteristics of patients in both groups were found to be comparable. In the IGFI group, the mean time to observe perfusion fluorescence was 26.3 ± 12.0 seconds post-ICG injection, and six patients needed to select a more proximal resection point due to insufficient fluorescence at their initial site of choice. Notably, the IGFI group exhibited a lower incidence of postoperative anastomotic leakage, with no significant disparities observed in terms of pathological outcomes, postoperative recovery, or other postoperative complication rates when compared to the control group (p > 0.05). This study underscores the potential of IGFI as a dependable and pragmatic tool for the assessment of anastomotic blood supply following esophagojejunostomy or esophagogastrostomy for gastric cancer. The use of IGFI may potentially reduce the occurrence of postoperative anastomotic leakage.

Indocyanine green (ICG) fluorescence imaging for prevention of anastomotic leak in totally minimally invasive Ivor Lewis esophagectomy: a systematic review and meta-analysis

Indocyanine green (ICG) fluorescence imaging is an emerging technology that might help decreasing anastomotic leakage (AL) rates. The aim of this study was to determine the usefulness of ICG fluorescence imaging for the prevention of AL after minimally invasive esophagectomy with intrathoracic anastomosis. A systematic literature review of the MEDLINE and Cochrane databases was performed to identify all articles on totally minimally invasive Ivor Lewis esophagectomy. Studies were then divided into two groups based on the use or not of ICG for perfusion assessment. Primary outcome was anastomotic leak. Secondary outcomes included operative time, ICG-related adverse reactions, and mortality rate. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for main outcomes. A total of 3,171 patients were included for analysis: 381 (12%) with intraoperative ICG fluorescence imaging and 2,790 (88%) without ICG. Mean patients' age and proportion of males were similar between groups. Mean operative time was also similar between both groups (ICG: 354.8 vs. No-ICG: 354.1 minutes, P = 0.52). Mean ICG dose was 12 mg (5-21 mg). No ICG-related adverse reactions were reported. AL rate was 9% (95% CI, 5-17%) and 9% (95% CI, 7-12%) in the ICG and No-ICG groups, respectively. The risk of AL was similar between groups (odds ratio 0.85, 95% CI 0.53-1.28, P = 0.45). Mortality was 3% (95% CI, 1-9%) in patients with ICG and 2% (95% CI, 2-3%) in those without ICG. Median length of hospital stay was also similar between groups (ICG: 13.6 vs. No-ICG: 11.2 days, P = 0.29). The use of ICG fluorescence imaging for perfusion assessment does not seem to reduce AL rates in patients undergoing minimally invasive esophagectomy with intrathoracic anastomosis.

Intra-operative visualization of the common bile duct by ICG fluorescence imaging during a near-total pancreatectomy in an infant

Purpose: Drug-resistant diffuse congenital hyperinsulinism in infants is treated with a near-total pancreatectomy. However, dissection of the intra-pancreatic segment of the common bile duct (CBD) is technically challenging, especially with a laparoscopic approach in the very young. Method: We performed a laparoscopic near-total pancreatectomy in a 10 month old child with congentinal hyperinsulinism, and used intra-operative intravenous administration of 0,5 mg / kg indocyanine green (ICG) to visualize the CBD while dissecting pancreatic tissue. Results: Direct vision of the CBD by ICG fluorescence imaging resulted in a succesfull laparoscopic near-total pancreatectomy in this patient, with an adequate amount (95% - 98%) of pancreatic tissue dissected without causing any iatrogenic injury. The postoperative course was uncomplicated, the pharmaceutcical therapy was stopped, and the carbohydrate diet was normalized over time without resulting in hypoglycemic episodes. Conclusion: Intra-operative use of ICG fluorescence imaging could guide surgeons while performing a laparoscopic near-total pancreatectomy in infants with congenital hyperinsulinism to safely dissect the intra-pancreatic segment of the CBD.

Endoscopic-assisted ICG (EASI) technique for sentinel lymph node biopsy in breast cancer

Sentinel lymph node biopsy is currently the standard of care for axillary staging in early breast cancer patients with no clinical or radiological evidence of axillary lymph node involvement. Novel techniques studied in recent years include the use indocyanine green (ICG) fluorescence imaging, which was reported in a recent network meta-analysis to be comparable to standard dual modality in terms of false negative as well as detection rate. However, there have been no standardized operative methods leading to the underutilization of this modality in clinical practice. In addition, technical limitations such as the difficulty in tracing ICG flow in obese patients further restrict the use of ICG fluorescence in sentinel lymph node biopsy. In this article, we describe in detail the use of the endoscopic-assisted ICG technique in performing sentinel lymph node biopsy, which addresses limitations associated with conventional use of ICG fluorescence imaging. The technical novelty of this technique lies in the fact that it has not been previously described in the literature and it allows for the identification of sentinel lymph nodes with minimal incision and tissue disruption as well.

Indocyanine Green Fluorescence Imaging in Predicting Wound Healing After Limb Revascularization

Introduction - The most severe form of peripheral arterial disease is chronic limb threatening ischemia with tissue lesion. Assessment of critically ischemic foot is challenging.The conventional assessment methods are pressure measurements from ankle and toe level, ankle-brachial index (ABI) and transcutaneous oxygen pressure (TcPO2). Indocyanine green fluorescence imaging (ICG-FI) a relatively recent imaging method and still developing in many ways. The principle of ICG-FI is to illuminate the tissue of interest with light at the excitation wavelength (about 750 to 800nm) while observing it at longer emission wavelengths (over 800nm). ICG-FI gives a view of foot hemodynamic. After an intravenous injection of ICG, perfusion of the foot can be visualized with infrared camera and recorded for further analysis. Intensity of the fluorescence as a function of time can be analysed from the recorded images allowing a time-intensity curve to be drawn. We have earlier published analysis on the repeatability of ICG-FI and use of ICG-FI in immediate quality control after revascularization. In the current study we have analysed the use of ICG-FI in predicting wound healing after revascularization of CLTI and tissue lesion. Methods - Between January 2015 and February 2016 73 patients with CLTI and tissue lesion underwent either surgical (n=24) or endovascular (EVR) (n=49) revascularization. ICG-FI was done using Spy Elite before the revascularization, immediately after and during the follow-up. Maximum intensity, intensity rate and the relative change in the intensity rate were extracted from the automatic time intensity curve report. Results - During the mean follow-up of 16 months 77% of the wounds healed. 12 patients died and 9 had major amputation of the index leg. 4 mo, 6mo and overall wound healing rates were 51% and 63% respectively. The mean maximum intensity increased in the wound area from 92 (SD 61) AU to 132 (SD62) AU. The three parameters, change in maximum intensity, change in intensity rate and relative change in intensity rate were testes using ROC. The best area under curve was achieved with the absolute change in maximum intensity. 19AU increase predicted overall wound healing with 69% sensitivity and 68% specificity (AUC 0.79). 35 AU increase in intensity predicted wound healing in 4 months with 64% sensitivity and 63% specificity (AUC 0.68), 30 AU increase predicted wound healing in 6 months with 69% sensitivity and 69% specificity (AUC 0.72). In patients who underwent EVR the mean maximum intensity increased from 99.7 (SD 60.9) to 127.1 (SD 62.1) in the wound area. The corresponding increase in patients who underwent bypass was from 79.6 (SD60.1) AU to 140 (SD 62.9) AU (p<0.001). One-year wound healing rate after EVR was 84% and after bypass 92%. Conclusion - ICG-FI shows well the success of revascularization in individual patient. In our analysis the best parameter in predicting wound healing was absolute change in maximum intensity. The higher the change is achieved, the faster is the wound healing.

Mechanotechnical faults and particular issues of anastomotic complications following robot-assisted anterior resection in 968 rectal cancer patients.

As most risk factors for anastomotic complications (AC) in rectal cancer patients appear to be noncorrectable, it is needed to find the correctable causes. Additionally, the outcomes of indocyanine-green fluorescence imaging (IFI) and robot-stapled anastomosis have yet been undetermined. This study retrospectively analyzed 968 consecutive patients with rectal cancer, who underwent curative robot-assisted anterior resections between 2010 and 2018. IFI parameters and stapling features in the surgical records were reviewed, and reconfirmed. AC occurred in 54 patients (5.6%), 34 (3.5%) with anastomotic leakage (AL) and 24 (2.5%) with anastomotic stenosis (AS). Mechanotechnical faults including defective stapling configurations, including angles lesser than or equal to 150° and outer deviation (more than half from the center of the circle) of linear staples, between the two linear staples were independently associated with AL (P < .001 each). IFI significantly reduced AL rate (2.5% vs 5.3%, P = .029) and AS rate (2% vs 18.8%, P = .006), respectively. Robot linear stapling enabled to maintain the obtuse angle during consecutive staplings and reduced console time. AL and AS were independent risk factors for disease-free survival (P = .02) and local recurrence (P = .03), respectively. AC were associated with some correctable causes, namely, mechanotechnical errors and lack of use of IFI.

Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis.

Indocyanine green (ICG) fluorescence imaging has been proven to be an effective tool to assess anastomotic perfusion. The aim of this systematic review and meta-analysis was to evaluate its efficacy in reducing the anastomotic leakage (AL) rate after colorectal surgery. PubMed, Scopus, WOS, Google Scholar and Cochrane Library were searched up to January 2017 for studies comparing fluorescence imaging with standard care. ClinicalTrials.gov register was searched for ongoing trials. The primary outcome measure was AL rate with at least 1month of follow-up. ROBINS-I tool was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data. One thousand three hundred and two patients from 5 non-randomized studies were included. Fluorescence imaging significantly reduced the AL rate in patients undergoing surgery for colorectal cancer (OR 0.34; CI 0.16-0.74; p=0.006). Low AL rates were shown in rectal cancer surgery (ICG 1.1% vs non-ICG 6.1%; p=0.02). There was no significant decrease in the AL rate when colorectal procedures for benign and malignant disease were combined. To date, there are no published randomized control trials (RCTs) on this subject, though 3 ongoing RCTs were identified. ICG fluorescence imaging seems to reduce AL rates following colorectal surgery for cancer. However, the inherent bias of the non-randomized studies included, and their differences in AL definition and diagnosis could have influenced results. Large well-designed RCTs are needed to provide evidence for its routine use in colorectal surgery.

Quality Control of the Foot Revascularization Using Indocyanine Green Fluorescence Imaging.

Critical limb ischemia (CLI) is a clinical diagnosis, confirmed by objective tests, usually ankle-brachial index (ABI), toe pressure (TP) and TcPO2. Furthermore, the anatomical lesions in patients affected by CLI were visualized by ultrasound, angiography, CTA, or MRA. Indocyanine green fluorescence imaging (ICG-FI) is a diagnostic modality for assessing foot perfusion. We aimed to study the usefulness of ICG-FI in the quality control of revascularization. One hundred and four CLI limbs in 101 patients were studied with ICG-FI using SPY Elite before and after open or endovascular revascularization. ABI and TP were also measured. After ICG-FI, assessment of circulation was done using time-intensity curve derived from the two regions of interest the one being in the plantar side of the foot and the other in the dorsal side of the foot. Three parameters were derived from the curves: maximum intensity (the absolute value of the maximum intensity); intensity rate (the value from the time-intensity curve describing the increase in maximum intensity/s) and SPY10 (the intensity achieved during the first 10s after the foot starts to gain intensity). Sixty-two limbs presented category 3 of Rutherford classification, 12 limbs category 4, and 30 limbs category 5. Ninety-five technically successful procedures were achieved, 63 (66.3%) endovascular and 32 (33.7%) surgical revascularizations. In 9 (9.5%) patients, an in-line flow from the aorta to the foot was not achieved due to a failure to recanalize the occlusion (n=7) or due to distal embolization (n=2). ABI was not reliable in 58 patients (57.4%) mostly due to pseudohypertension and TPs in 49 (48.5%) patients mostly due to previous minor amputations. ICG-FI was successful in all patients. The mean intensity values before and after the procedure in patients who underwent successful revascularization were 81±47 units and 120±5 units of intensity (p<.001) and intensity rates 4.2±4 and 8.0±6.2units/s (p=.001), respectively. In the PTA patients in whom the revascularization was unsuccessful, no changes were seen in the hemodynamic parameters. In 6 (8.8%) patients who underwent technically successful revascularization, the SPY values were worse after the revascularization than at the baseline. ICG-FI with SPY Elite provides reliable information on the increase in perfusion after revascularization, in addition to implicating possible failure if there is no improvement in the ICG-FI variables. Unlike ABI and TP, it can be performed in all patients. It gives valuable information to complement traditional assessment methods.

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer.

Nodal staging is used in colorectal cancer (CRC) to determine which patients should receive adjuvant chemotherapy. The aim of this study was to evaluate the role of indocyanine green fluorescence imaging (ICG-FI) in sentinel lymph node (SLN) detection compared to the standard technique. Twenty patients with CRC admitted for elective colectomy were included (NCT01995591). Ex vivo SLN detection was performed using patent blue (PB) and free ICG injected around the tumor. Identification rates were 95% (19/20) for both techniques. Sensitivity was 43% for PB and 57% for ICG. Correlation between the techniques was 83%. FI was more sensitive in patients with body mass index (BMI) >25 kg/m(2) Serial section analysis did not allow for up-staging of patients. The use of ICG-FI is superior to the blue dye technique in patients with a BMI >25 kg/m(2) However, the sensitivity of ICG-FI in SLN detection remains low, with a high rate of false-negative results.

Assessment of Foot Perfusion Before and After Revascularization of Critically Ischemic Foot Using Indocyanine Green Fluorescence Imaging

Introduction: Critical limb ischemia (CLI) is a clinical diagnosis, confirmed by objective tests, usually ABI, toe pressure (TP) and TcPO2. Indocyanine green fluorescence imaging (ICG-FI) is a diagnostic modality for assessing the perfusion of tissues. Although some application has been described of ICG-FI in the assessment of ischemic foot, the technique is uncommon in vascular surgery. Our aim was to study the usefulness of ICG-FI in the quality control of revascularization. Methods: One hundred and one patients with 104 CLI limbs were studied with ICG-FI using SPY Elite. ABI and TP were measured in all patients. After ICG-FI, assessment of circulation was done using time–intensity curve derived from two regions of interest. Three parameters were derived from the curves: Maximum ingress, meaning the absolute value of the maximum intensity; ingress rate, meaning the value from the time intensity curve describing the increase in maximum ingress per seconds and SPY10, which is the intensity achieved during the first 10 seconds after the foot starts to gain intensity. Results: Ninety-five technically successful procedures was achieved, 63 (66.3%) endovascular and 32 (33.7%) surgical revascularizations. In 9 (9.5%) patients, an open line from the aorta to the foot was not achieved due to a failure to recanalize the occlusion (n = 7) or due to distal embolization (n = 2). The mean ingress values before and after the procedure in patients who underwent successful revascularization were 81 ± 47 units and 120 ± 5 units of ingress (p < .001) and ingress rates 4.2 ± 4 units/second and 8.0 ± 6.2 units/second (p = .001), respectively. In the PTA patients in whom the revascularization was unsuccessful, no changes were seen in the hemodynamic parameters. In 6 (8.8%) patients who underwent technically successful revascularization, the SPY values were worse after the revascularization than at the baseline. In all cases an explanation was found in closer evaluation. Conclusion: ICG-FI with SPY Elite provides reliable information on the success of revascularization, in addition to implicating possible failure if there is no improvement in the ICG-FI variables. It gives valuable information to complement traditional assessment methods. Disclosure of Interest: None Declared.

Usefulness of indocyanine green-fluorescence imaging during laparoscopic hepatectomy

Usefulness of indocyanine green-fluorescence imaging during laparoscopic hepatectomy

Usefulness of Indocyanine Green-Fluorescence Imaging for Visualization of the Bile Duct During Laparoscopic Liver Resection

Usefulness of Indocyanine Green-Fluorescence Imaging for Visualization of the Bile Duct During Laparoscopic Liver Resection

A novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with oral cancer using intra-arterial chemotherapy - preliminary study

BackgroundRecent progress in ICG (indocyanine green) fluorescence imaging has provided a means by which we can detect sentinel lymph nodes (SLNs) without the risk of exposing patients to radiation. Neck metastasis is the most significant prognostic factor. It is imperative that early metastasis can be controlled. Intra-arterial chemotherapy is performed in order to preserve organs and to improve prognosis when treating oral cancer.ObjectiveEvaluate translymphatic chemotherapy targeting SLNs in patients with oral cancer using intra-arterial chemotherapy. Evaluation will be carried out through the measurement of CDDP concentrations in SLNs.MethodsFive patients with tongue cancer (T3N0M0) were treated by intra-arterial chemotherapy as neoadjuvant chemotherapy from November 2010 to June 2011. After a week of chemotherapy, patients underwent surgical treatment including the partial resection of the tongue and neck dissection. Intra-arterial chemotherapy was administered at 50 mg/m2 of CDDP either one or two times weekly. 5 mg of ICG was administered to the lingual artery at the beginning of surgery. SLNs were detected using ICG fluorescence imaging. 0.1 g of SLNs and non-SLNs were resected in order to measure CDDP concentrations. The rests of each of the SLNs were examined intraoperatively by routine frozen pathological examination. SLNs were also identified using radioactive injection the day prior to surgery.ResultsThe mean CDDP concentrations in the SLNs and non-SLNs were 1.2 μg/g and 0.35 μg/g, respectively. Our intra- arterial infusion revealed that all metastatic lymph nodes, including SLNs, were without false negative SLNs. However, of 7 metastatic lymph nodes, one was not identified by means of conventional method.ConclusionOur findings verified the possibility that intra-arterial chemotherapy may be effective not only for organ preservation therapy, but also efficient in translymphatic chemotherapy targeting SLNs in patients with oral cancer through the use of ICG fluorescence imaging.

Indocyanine green (ICG) fluorescence imaging versus radioactive colloid for sentinel lymph node identification in patients with breast cancer.

674 Background: The usefulness of ICG fluorescence imaging produced by near-infrared ray for sentinel lymph node (SLN) identification in patients with breast cancer has been revealed. We herein compared and evaluated the outcomes between ICG fluorescence imaging with dye (ICG) and radioactive colloid with dye (RAC) in SLN identification in patients with operable breast cancer. Methods: Between March 2004 and December 2009, 309 patients with a tumor less than 3 cm in diameter and node-negative consisted of 149 patients in ICG and 160 in RAC were enrolled in this study. The mean age was 55 years in ICG and 54 in RAC. In the former, ICG was injected subdermally in the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were visible by fluorescence imagings (Photodynamic eye: PDE, Hamamatsu Photonics Co.) immediately. After incising the axillary skin 1 cm cranial side from the disappeared point of fluorescence image, SLN was then dissected under the guidance of fluorescence with adequate adjustment of sensitivity. In the latter, radioactive colloid was injected subdermally in the areola the day before. After incising the axillary skin on the strong point of gamma probe (Navigator GPS power probe), SLN was then dissected under the guidance of gamma probe. Results: There were no significant differences between age, cancer stage and surgical procedures. The identification rate was 98.7% in ICG and 96.9% in RAC, respectively. The mean number of SLN was 3.7 (range: 1-11) in ICG and 2.0 (range 1-5) in RAC. The lymph node metastasis was revealed in 13.4% of ICG group and 13.8% of RAC group. The false negative rate was 0.67% in ICG and 0.62% in RAC. There were no intra- or postoperative complications associated with SLN identification. The cost was $46,007 (PDE: $46,000, ICG: $6.7) in ICG and $60,030 (GPS: $60,000, RAC: $30) in RAC. There were no significant differences in surgical outcomes between both methods. Conclusions: The evaluation of ICG fluorescence imaging is equal to that of radioactive colloid. In particular, ICG fluorescence imaging for SLN identification will be a greatly helpful tool for institutions without radioactive equipment. No significant financial relationships to disclose.