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Review
. 2025 May 1;111(5):3386-3398.
doi: 10.1097/JS9.0000000000002311.

The role of indocyanine green in fluorescence-guided pancreatic surgery: a comprehensive review

Andrea Tufo  1 , Anna Caterina Milanetto  2 , Roberto Valente  3   4 , Enrico Spalice  5 , Loredana Sodano  1 , Claudio Pasquali  2 , Maria Chiara Scandavini  3 , Alessandro Coppola  5
Affiliations
Review

The role of indocyanine green in fluorescence-guided pancreatic surgery: a comprehensive review

Andrea Tufo et al. Int J Surg. .

Abstract

Pancreatic surgery is a complex and challenging field, with patients facing a high risk of postoperative complications. In recent years, indocyanine green (ICG) has gained prominence as a valuable tool used in various aspects of pancreatic surgery. ICG is a fluorescent dye that offers real-time imaging capabilities that enhance the surgeon's ability to accurately localize tumors and critical anatomical structures, thereby improving surgical precision and potentially reducing operative time and complications. One of the most significant advantages of ICG is its ability to provide enhanced visualization of the biliary tract and vascular structures, which is particularly beneficial in complex pancreatic resections, in which the anatomy can be highly variable and challenging to navigate. Furthermore, ICG can be instrumental in ensuring the adequate perfusion of anastomoses, thereby reducing the risk of postoperative leaks and associated morbidity. This comprehensive review aims to provide an in-depth analysis of the current applications, advantages, and limitations of ICG in pancreatic surgery.

Keywords: indocyanine green; mininvasive surgery; pancreas surgery; pancreatic cancer; precision surgery.

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Figures

Figure 1.
Figure 1.
Pancreatic uncinate process and adjacent vessels during different timing after ICG bolus. (A) Before IV ICG bolus, with continuous infusion. (B) Arterial phase, 10 s after bolus. Notice the increased fluorescence of a superior mesenteric artery branch to the pancreas. (C) Venous phase, 40 s after bolus. Superior mesenteric vein is hyperfluorescent. ICG, indocyanine green; IV, intravenous. Courtesy of Abun et al.[12]
Figure 2.
Figure 2.
Common bile duct identification. Courtesy of Dr. D. Marchi unpublished picture.
See this image and copyright information in PMC

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