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Review
. 2018 Aug;118(2):283-300.
doi: 10.1002/jso.25105. Epub 2018 Jun 24.

A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery

Labrinus van Manen  1 , Henricus J M Handgraaf  1 , Michele Diana  2   3   4 , Jouke Dijkstra  5 , Takeaki Ishizawa  6 , Alexander L Vahrmeijer  1 , Jan Sven David Mieog  1
Affiliations
Review

A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery

Labrinus van Manen et al. J Surg Oncol. 2018 Aug.

Abstract

Near-infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.

Keywords: image-guided surgery; near-infrared; oncology; optical imaging; tumor.

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Figures

Figure 1
Figure 1
Flow‐chart of the literature search strategy
Figure 2
Figure 2
Example of lymph node mapping in bladder cancer during surgery and ex vivo. Upper panel: arrowheads indicate the NIR fluorescent lymph nodes along the left external iliac vein during surgery. Lower panel: fluorescent lymph nodes after excision. Reprinted by permission from John Wiley and Sons: Journal of Surgical Oncology49 © 2014
Figure 3
Figure 3
Example of two colorectal liver metastases detected by NIRF imaging. White arrow: a fluorescent lesion, which was not detected by preoperative imaging. Dashed arrow: a preoperative suspected lesion could be recognised by its characterizing fluorescent rim. Reprinted by permission from Elsevier: European Journal of Surgical Oncology103 © 2017
Figure 4
Figure 4
Example of bile duct imaging using ICG 24 h after injection. The position of the common bile duct was indicated by the arrow; the liver by L; and surrounding adipose tissue by Ad. Adapted and reprinted by permission from Springer Nature: Surgical Endoscopy171 © 2014
Figure 5
Figure 5
Example of ureter imaging using MB. Upper panel: NIRF image of right ureter, 45 min after MB administration. Lower panel: NIRF image of right ureter, covered by blood and tissue. Reprinted by permission from Elsevier: The Journal of Urology190 © 2013
Figure 6
Figure 6
The concept of quantitative fluorescence measurements (Fluorescence‐based Enhanced Reality = FLER) for determining the bowel perfusion. Upper panel: The fluorescence signal is analyzed during 40 s after intravenous administration of ICG. Using specific software (VR‐PERFUSION, IRCAD; France) the slope of the fluorescence time‐to‐peak is computed and converted to color codes, resulting in a virtual perfusion cartography. Lower panel: The white light image is combined with the perfusion cartography, creating an augmented reality view of the bowel perfusion at the resection site
See this image and copyright information in PMC

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