Kai Nowak1, Ioannis Karampinis2, Andreas Lutz Heinrich Gerken2. 1. Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany. 2. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Mannheim, Germany.
Abstract
BACKGROUND: Through the improvement and implementation of advanced intraoperative imaging, the indications for intraoperative fluorescence have spread to various fields of visceral surgery. Indocyanine green (ICG)-based fluorescence angiography and the imaging systems using this certain dye are currently the cornerstone of intraoperative, fluorescence-based medical imaging. SUMMARY: The article focuses on principles and approaches of intraoperative fluorescence in general surgery. The current clinical practice of intraoperative fluorescence and its evidence are described. Emerging new fields of application are put in a perspective. Furthermore, the technique and possible pit-falls in the performance of intraoperative ICG fluorescence angiography are described in this review article. KEY MESSAGES: Overall growing evidence suggests that intraoperative fluorescence imaging delivers valuable additional information to the surgeon, which might help to perform surgery more exactly and reduce perioperative complications. Perfusion assessment can be a helpful tool when performing critical anastomoses. There is evidence from prospective and randomized trials for the benefit of intraoperative ICG fluorescence angiography during esophageal reconstruction, colorectal surgery, and surgery for mesenteric ischemia. Most studies suggest the administration of 2.5-10 mg of ICG. Standardized settings and documentation are essential. The benefit of ICG fluorescence imaging for gastrointestinal sentinel node detection and detection of liver tumors and colorectal metastases of the liver cannot clearly be estimated duo to the small number of prospective studies. Critical points in the use of intraoperative fluorescence imaging remain the low standardization and reproducibility of the results and the associated difficulty in comparing the results of the existing trials. Furthermore, little is known about the influence of hemodynamic parameters on the quantitative assessment of ICG fluorescence during surgery.
BACKGROUND: Through the improvement and implementation of advanced intraoperative imaging, the indications for intraoperative fluorescence have spread to various fields of visceral surgery. Indocyanine green (ICG)-based fluorescence angiography and the imaging systems using this certain dye are currently the cornerstone of intraoperative, fluorescence-based medical imaging. SUMMARY: The article focuses on principles and approaches of intraoperative fluorescence in general surgery. The current clinical practice of intraoperative fluorescence and its evidence are described. Emerging new fields of application are put in a perspective. Furthermore, the technique and possible pit-falls in the performance of intraoperative ICG fluorescence angiography are described in this review article. KEY MESSAGES: Overall growing evidence suggests that intraoperative fluorescence imaging delivers valuable additional information to the surgeon, which might help to perform surgery more exactly and reduce perioperative complications. Perfusion assessment can be a helpful tool when performing critical anastomoses. There is evidence from prospective and randomized trials for the benefit of intraoperative ICG fluorescence angiography during esophageal reconstruction, colorectal surgery, and surgery for mesenteric ischemia. Most studies suggest the administration of 2.5-10 mg of ICG. Standardized settings and documentation are essential. The benefit of ICG fluorescence imaging for gastrointestinal sentinel node detection and detection of liver tumors and colorectal metastases of the liver cannot clearly be estimated duo to the small number of prospective studies. Critical points in the use of intraoperative fluorescence imaging remain the low standardization and reproducibility of the results and the associated difficulty in comparing the results of the existing trials. Furthermore, little is known about the influence of hemodynamic parameters on the quantitative assessment of ICG fluorescence during surgery.
Authors: Ioannis Karampinis; Michael Keese; Jens Jakob; Vytautas Stasiunaitis; Andreas Gerken; Ulrike Attenberger; Stefan Post; Peter Kienle; Kai Nowak Journal: J Gastrointest Surg Date: 2018-07-10 Impact factor: 3.452
Authors: Ioannis Karampinis; Giovanna Di Meo; Andreas Gerken; Vytautas Stasiunaitis; Alexander Lammert; Kai Nowak Journal: Zentralbl Chir Date: 2018-08-22 Impact factor: 0.942
Authors: F Ris; E Liot; N C Buchs; R Kraus; G Ismael; V Belfontali; J Douissard; C Cunningham; I Lindsey; R Guy; O Jones; B George; P Morel; N J Mortensen; R Hompes; R A Cahill Journal: Br J Surg Date: 2018-04-16 Impact factor: 6.939
Authors: G Armstrong; J Croft; N Corrigan; J M Brown; V Goh; P Quirke; C Hulme; D Tolan; A Kirby; R Cahill; P R O'Connell; D Miskovic; M Coleman; D Jayne Journal: Colorectal Dis Date: 2018-06-08 Impact factor: 3.788
Authors: Anne-Sophie Mehdorn; Jan Henrik Beckmann; Felix Braun; Thomas Becker; Jan-Hendrik Egberts Journal: J Clin Med Date: 2021-01-25 Impact factor: 4.241
Authors: Gian Luca Baiocchi; Gianluca Guercioni; Nereo Vettoretto; Stefano Scabini; Paolo Millo; Andrea Muratore; Marco Clementi; Giuseppe Sica; Paolo Delrio; Graziano Longo; Gabriele Anania; Vittoria Barbieri; Pietro Amodio; Carlo Di Marco; Gianandrea Baldazzi; Gianluca Garulli; Alberto Patriti; Felice Pirozzi; Raffaele De Luca; Stefano Mancini; Corrado Pedrazzani; Matteo Scaramuzzi; Marco Scatizzi; Lucio Taglietti; Michele Motter; Graziano Ceccarelli; Mauro Totis; Andrea Gennai; Diletta Frazzini; Gianluca Di Mauro; Gabriella Teresa Capolupo; Francesco Crafa; Pierluigi Marini; Giacomo Ruffo; Roberto Persiani; Felice Borghi; Nicolò de Manzini; Marco Catarci Journal: BMC Surg Date: 2021-04-10 Impact factor: 2.102