Ann Surg Treat Res.  2023 Nov;105(5):252-263. 10.4174/astr.2023.105.5.252.

Fluorescence-guided colorectal surgery: applications, clinical results, and protocols

• Jung JM
• Park IJ
• Park EJ
• Son GM
• on behalf of Image-Guided Surgery Study Group of Korean Society of Coloproctology

• KMID: 2547530
• DOI: http://doi.org/10.4174/astr.2023.105.5.252

Abstract

In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750–800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG’s role, advantages, disadvantages, and potential clinical impact in colorectal surgery.

Keyword

Colorectal surgery; Fluorescent dyes; Indocyanine green

Figure

• 

  Fig. 1 Indocyanine green-fluorescence image (ICG-FI) use for anastomotic safety. Sigmoid colon image under standard white light (A), ICG-FI with red inversion mode (B), time-fluorescence curve of ICG angiography for quantitative perfusion analysis, during laparoscopic low anterior resection for rectal cancer patients. (C) Fluorescent intensity curves have a common transitional area within 4–5 cm as an optimal zone to analyze the fluorescence images (D). Adapted from Son et al. [2] and Ahn et al. [8], according to the Creative Commons License.

• 

  Fig. 2 Fluorescence lymph node mapping using 3 different NIR imaging systems. (A–C) Stryker, 1588 AIM camera system; (D–F) Karl Storz, IMAGE1 S; and (G–I) Olympus, CLV-S200-IR. (A), (D), and (G) show the mesentery of the colon under white light. Adapted from Ahn et al. [41], according to the Creative Commons License.

• 

  Fig. 3 Optimal indocyanine green (ICG) tattooing protocol. Within a submucosal ICG injection dosage of 0.5–1.0 mg, the protocol was optimized as the highest success rate of fluorescence lymph node mapping along with tumor localization and ICG angiography during a single surgery. Adapted from Ahn et al. [41], according to the Creative Commons License.

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