Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 270-275
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.270
Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions
Davina Perini, Jacopo Martellucci
Davina Perini, Jacopo Martellucci, Department of Emergency, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Firenze 50041, Italy
Author contributions: Perini D and Martellucci J contributed to this paper; Perini D and Martellucci J designed the overall concept; Perini D contributed to the design of the manuscript and the writing; Martellucci J contributed to the discussion and the editing; Perini D and Martellucci J contributed to the review of literature.
Conflict-of-interest statement: Perini D and Martellucci J certify that there is no actual or potential conflict of interest in relation to this editorial and they state that there are no financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions, implications, or opinions stated-including pertinent commercial or other sources of funding for the individual author(s) or for the associated department(s) or organization(s), personal relationships, or direct academic competition.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jacopo Martellucci, MD, PhD, Surgeon, Department of Emergency, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Largo G. Alessandro Brambilla, 3 Firenze, Firenze 50041, Italy. jamjac64@hotmail.com
Received: November 23, 2023
Peer-review started: November 23, 2023
First decision: December 17, 2023
Revised: December 30, 2023
Accepted: January 23, 2024
Article in press: January 23, 2024
Published online: February 27, 2024
Processing time: 94 Days and 7 Hours
Abstract

Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in the emergency setting. Clinical trials have consistently shown that indocyanine green (ICG)-guided surgery can dramatically reduce the risk of postoperative complications, length of in-hospital stay and total healthcare costs in the elective setting. It is well-known that emergency surgery has a higher complication rate than its elective counterpart, therefore an impelling need for research studies to explore, validate and develop this issue has been highlighted. The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies. Furthermore, we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations. In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases. We then deepened the two most described topics in ICG-guided emergency surgery: Acute cholecystitis and intestinal ischemia, focusing on both the advantages and limitations of green-fluorescence application in these two fields. In emergency situations, ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity, facilitating the detection of intestinal ischemic zones, identifying biliary tree anatomy, reducing post-operative complications, and mitigating high mortality rates. The need to improve its application still exists, therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emergency procedures.

Keywords: Indocyanine green; Fluorescence; Navigation surgery; Angiography; Emergency surgery; Decision-making

Core Tip: Indocyanine green (ICG)-fluorescence is a novel cornerstone in the era of navigation surgery with the potential for reducing perioperative complications and better postoperative outcomes. The use of ICG in general surgery began in the field of oncologic surgery and then spread to other surgical areas. The ICG-guided emergency surgery is still in its infancy but represents a very promising scope of application. The experience of fluorescence-guided elective surgery can be of great help in implementing its use in emergency settings, increasing its application, and overcoming its limitations.