Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 715 - файл

Fluorescence-guided surgery (FGS) is a medical imaging tech­nique used to detect uorescently labeled structures during sur­gery. Camera systems that detect near-infrared (NIR) light not visible to the human eye guide can provide information about anatomy or tissue viability to the surgeon through real-time visu­alization in the operating eld. Indocyanine green (ICG) is the only NIR uorescent agent currently approved for human use. ICG is a safe, water-soluble compound that received FDA approval in the 1950s. Despite the bright green color of the reagent to the human eye, its use as a contrast agent is based on its robust uorescence in the NIR range. Applications for ICG in the pediat­ric world are emerging. ICG can be used for arteriogram, veno­gram, or general perfusion assessment of tissues such as intestinal perfusion before anastomosis or soft tissue pedicles or aps dur­ing plastic surgery. ICG is exclusively cleared by the liver and the bile duct and is applied in uorescence cholangiography. When administered as an intradermal, ICG gets protein-bound and con­ned to clearance via the lymphatic system, which is used to facil­itate sentinel lymph node detection and biopsy.

Indocyanine green (ICG) is the only NIR uorescent agent cur­rently approved for human use. ICG is a water-soluble, anionic, amphiphilic tricarbocyanine (776 Da) that rapidly binds to plasma proteins in the body. ICG was rst produced in 1955 by Kodak Research Laboratories and received FDA approval for retinal angiography in 1959. Historically, it has been used to measure cardiac output and hepatic function and for retinal angiography. After intravenous application, ICG remains largely protein-bound in the intravascular space and is cleared exclusively by the liver. ICG allows multiple uses due to its short intravascular half-life of 150 to 180 s. From the vasculature, ICG undergoes uptake by hepatocytes and hepatic clearance. The dye can then be detected

within minutes, peaks over the course of hours, and continues for over a day after typical dosing. When administered intradermally, ICG gets protein-bound and conned to clearance via the lym­phatic system, which is used to facilitate sentinel lymph node detection and biopsy.

Fluorescence-guided surgery (FGS) has been used across multi­ple elds with signicantly improved outcomes and decreased complications. Throughout its history, ICG has maintained a high safety index with a favorable side effect prole and severe com­plications are infrequent. Albeit rare, adverse reactions to ICG have been reported throughout the literature. These include dys­pnea, wheezing, cough, cyanosis, headache, urticaria, nausea, pruritus, hypotension, cough, anxiety, laryngospasm, laryngo­bronchospasm, pulmonary congestion, facial edema, anaphylactic shock, and death [3, 4]. More recently, Shafy et al. evaluated intraoperative administration of ICG in 100 patients, who ranged in age from 5 days old to 31 years old, with a median age of 12 years. Procedures included laparoscopic cholecystectomy, colorectal surgery, sagittal anorectovaginourethroplasty, transanal pull-through for Hirschsprung’s disease, perineal reconstruction, exploratory laparotomy, and renal procedures. ICG was adminis­tered IV to all patients with a median dose of 1.1mL (2.5mg/mL ICG solution). In this cohort, they found no hemodynamic or respiratory alterations due to ICG usage. None of these patients needed treatment with an anticholinergic drug, a vasoactive drug, or a drug to treat bronchospasm [5]. Recent literature continues to describe uncommon adverse reactions such as anaphylactic shock to ICG [6, 7]. ICG contains sodium iodide and there are rare reports about anaphylaxis or urticarial reactions (1:10,000, as reported by the manufacturer). Iodine uptake studies should not be performed for a week following its use. Lastly, there is no data to support or contraindicate use in pregnant or nursing mothers.