Indocyanine green (ICG), a fluorescent dye, has been making significant strides in the field of laparoscopic surgery. It has revolutionized the way surgeons visualize and assess tissue, leading to improved surgical outcomes and patient care.
The Power of ICG Fluorescence Imaging in Surgical Visualization
ICG is injected intravenously through a filter and rapidly binds to albumin in the bloodstream. When illuminated with near-infrared light, it emits fluorescence, which can be detected by specialized cameras. This fluorescence allows surgeons to visualize blood flow, lymphatic drainage, and tissue perfusion in real-time.
Optimizing Surgical Outcomes with Indocyanine Green (ICG)
- Enhanced Visualization: ICG offers a clear view of blood vessels, lymph nodes, and intricate structures, enhancing surgical precision and reducing risks.
- Improved Perfusion Assessment: Monitoring blood flow helps identify tissue ischemia and necrosis, guiding treatment decisions.
- Lymphatic Mapping: ICG aids in mapping lymphatic drainage for cancer staging and treatment planning, particularly in breast and colorectal surgery.
- Reduced Complications: Better visualization and perfusion assessment with ICG help prevent harm to vital structures and lower postoperative risks.
- Improved Patient Outcomes: Implementing ICG in laparoscopic surgery leads to enhanced outcomes, with shorter hospital stays, decreased pain, and quicker recovery times.
Using ICG for Enhanced Surgical Precision
Laparoscopic Surgery:
In Laparoscopic Cholecystectomy it is used to visualize the biliary system.
The Common Hepatic Duct(CHD), Common Bile Duct(CBD) are well seen with ICG but to visualize the gall bladder takes time. Usually more than 45 minutes. Ideally it should be given 30 to 120 minutes before the procedure.
If there is a stone impacted in the neck of the gall bladder, the ICG will not go into the gall bladder and the gall bladder will not be lit up with ICG.
The main use of ICG is in the prevention of biliary injuries. In laparoscopic cholecystectomy, the goal is to place clips on the cystic duct at its junction with the gallbladder, rather than at the junction of the cystic duct and common bile duct. By maintaining the critical view of safety, we aim to secure the clips away from the common bile duct to avoid accidental injuries. ICG highlights the bile duct even if it is lying up to 1cm deeper to the fat and helps identify the vital anatomy thus preventing inadvertent injuries.
Liver tissue is well delineated green with ICG and thus identification of the plane of dissection between the GB and the liver bed is easily identified even in bad gall bladders aiding in dissecting the GB off the Glissen's capsule and preventing bleeding from the liver sinusoids allowing for a less bloody plane during surgery.
Vascular liver tumours pick up ICG faster than the rest of the liver and a clear plane of dissection can be identified to separate the tumour from the rest of the normal liver tissue.
ICG is also used to assess vascularity and viability of bowel before an anastomosis is performed. This greatly aids in the success of the anastomosis as hood vascularity is one of the single most important factors for a successful anastomosis.
Open Surgery:
* Oncology: Staging of cancers, lymphatic mapping, and sentinel node biopsy, esp in the breast.
* General Surgery: Assessment of tissue viability, detection of anastomotic leaks, and evaluation of bowel perfusion
* Vascular Surgery: Identification of arterial occlusions and venous thromboses
* Plastic Surgery: Flap monitoring and assessment of tissue viability
* Gynecology: Evaluation of uterine blood flow and detection of endometriosis
Conclusion:
Indocyanine green has emerged as a valuable tool in laparoscopic surgery, offering enhanced visualization, improved perfusion assessment, and reduced complications. As technology continues to advance, we can expect to see even more innovative applications of ICG in the future, leading to further improvements in patient care.
Images of ICG Surgery
Initial View of the liver
Gall bladder with patchy gangrene
Identification of the CBD before the start of dissection.
CBD Identified with dissected Calot's triangle
Cutting the Cystic duct after clear delineation of the bile duct.
If you had to undergo gall bladder surgery, would you prefer the surgery being done:
Using ICG
Without ICG
DNB (Gen. Surg.), F.MAS, FIAGES, FALS(Hernia), FALS (Colo-rectal)
Consultant Laparoscopic & General Surgeon
Bhatia Hospital, Breach Candy Hospital, B. D. Petit Parsee General Hospital, Masina Hospital, ACI Cumballa Hill Hospital & Conwest & Manjula S. Badani Jain Hospital.
Mumbai, India
Mob: +91 9833109876; For Appointments: +9122 66660234 or click here
E-mail: ksd@drksdastoor.com Website: www.drksdastoor.com
Gall bladder and other surgeries with ICG is routinely done by me at Breach Candy Hospital and Bhatia Hospital using the Karl Storz Rubina 4K system.
Please feel free to contact me here if you have any queries.
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