title: Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery.
abstract: BACKGROUND
  Recently major developments in video imaging have been achieved: among these, the use of high definition and 3D imaging systems, and more recently indocyanine green (ICG) fluorescence imaging are emerging as major contributions to intraoperative decision making during surgical procedures. The aim of this study was to present our experience with different laparoscopic procedures using ICG fluorescence imaging.
  
  
  METHODS
  108 ICG-enhanced fluorescence-guided laparoscopic procedures were performed: 52 laparoscopic cholecystectomies, 38 colorectal resections, 8 living-donor nephrectomies, 1 laparoscopic kidney autotransplantation, 3 inguino-iliac/obturator lymph node dissections for melanoma, and 6 miscellanea procedures. Visualization of structures was provided by a high definition stereoscopic camera connected to a 30° 10 mm scope equipped with a specific lens and light source emitting both visible and near infra-red (NIR) light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). After injection of ICG, the system projected high-resolution NIR real-time images of blood flow in vessels and organs as well as highlighted biliary excretion .
  
  
  RESULTS
  No intraoperataive or injection-related adverse effects were reported, and the biliary/vascular anatomy was always clearly identified. The imaging system provided invaluable information to conduct a safe cholecystectomy and ensure adequate vascular supply for colectomy, nephrectomy, or find lymph nodes. There were no bile duct injuries or anastomotic leaks.
  
  
  CONCLUSIONS
  In our experience, the ICG fluorescence imaging system seems to be simple, safe, and useful. The technique may well become a standard in the near future in view of its different diagnostic and oncological capabilities. Larger studies and more specific evaluations are needed to confirm its role and to address its disadvantages.
authors.affiliation: Minimally Invasive Surgery Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy, luigi.boni@uninsubria.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Giulia
authors.initials: G
authors.lastname: David
authors.forename: Alberto
authors.initials: A
authors.lastname: Mangano
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Spampatti
authors.forename: Elisa
authors.initials: E
authors.lastname: Cassinotti
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000098:blood supply*; D004396:Coloring Agents; D005260:Female; D005858:Germany; D006801:Humans; D007208:Indocyanine Green; D007668:Kidney / Q000098:blood supply*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D061848:Optical Imaging / Q000379:methods*; D010388:Pelvis
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green