Developments in the Use of Indocyanine Green (ICG) Fluorescence in Colorectal Surgery

Abstract

Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, numerous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, others, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative compounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

Keywords: Indocyanine Green; colorectal anastomosis; colorectal cancer; lymphatic mapping; tumor marking.

Figure 1

ICG fluorescence highlighting colonic perfusion after ligation of the inferior mesenteric artery during robotic low anterior resection. Imaging was performed using a da Vinci robotic surgical platform. (a) White light visualization of the rectosigmoid junction. (b) Near-infrared imaging prior to intravenous administration of ICG. (c) ICG fluorescence demonstrating perfusion change after ligation of the vascular pedicle.

Figure 2

Intraureteral ICG administration during medial-to-lateral dissection of the sigmoid colon during robotic low anterior resection. Imaging was performed using a da Vinci robotic surgical platform. (a) White light visualization of left retroperitoneum with sigmoid colon and mesentery reflected anteriorly. (b) ICG fluorescence demonstrates clear identification of the left ureter in the lower right portion of the image. Images provided by Dr. Mark Soliman, M.D.