Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2018; 24(27): 2921-2930
Published online Jul 21, 2018. doi: 10.3748/wjg.v24.i27.2921
Indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: State of the art and future directions
Gian Luca Baiocchi, Michele Diana, Luigi Boni
Gian Luca Baiocchi, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25125, Italy
Michele Diana, IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg 67000, France
Michele Diana, IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg 67000, France
Luigi Boni, General and Emergency Surgery, IRCCS - Ca’ Granda - Policlinico Hospital, Milan 20122, Italy
Author contributions: Baiocchi GL and Boni L conceived the study; Baiocchi GL, Diana M, and Boni L critically reviewed the literature and supplied the material to be included in the manuscript’s Figures; Baiocchi GL drafted the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: Baiocchi GL, Diana M, and Boni L have received no funding and declare no conflicts of interest in relation to this specific work. Baiocchi GL received a travel grant from Stryker and from Karl Storz and has been the scientific organizer of the international workshop “Intraoperative ICG Fluorescence Imaging in Hepatobiliary and Visceral Surgery: State of the Art and New Frontiers,” (Brescia, Italy, October 21, 2017) partly funded (travel expenses) by Karl Storz and Stryker companies. Diana M is the recipient of a grant from the ARC Foundation (Project ELIOS) to develop fluorescence image-guided surgery. Boni L is a consultant for Storz and Olympus.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gian Luca Baiocchi, MD, Professor, Department of Clinical and Experimental Sciences, University of Brescia, and Chirurgia Generale 3, Spedali Civili, P.le Spedali Civili 1, Brescia 25125, Italy. gianluca.baiocchi@unibs.it
Telephone: +39-30-3995600 Fax: +39-30-3397476
Received: May 18, 2018
Peer-review started: May 18, 2018
First decision: May 30, 2018
Revised: June 8, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: July 21, 2018
Processing time: 62 Days and 16.8 Hours
Abstract

In recent years, the use of fluorescence-guided surgery (FGS) to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. FGS relies on the fluorescence signal emitted by injected substances (fluorophores) after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green (ICG)-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The analysis, findings, and discussion presented here rely on the authors’ significant experience with this technique in their medical institutions, an up-to-date review of the most relevant articles published on this topic between 2014 and 2018, and lengthy discussions with key opinion leaders in the field during recent conferences and congresses. For each application, the benefits and limitations of this technique, as well as applicable future directions, are described. The imaging of fluorescence emitted by ICG is a simple, fast, relatively inexpensive, and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future. Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.

Keywords: Indocyanine green; Fluorescence imaging; Gastrointestinal surgery; Liver surgery; Biliary surgery; Pancreatic surgery; Visceral perfusion; Biliary anatomy; Peritoneal carcinomatosis

Core tip: In recent years, the use of fluorescence-guided surgery to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. It helps guide the surgical procedure and provides the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future.