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Application of fluorescence-guided surgery in the acute care setting: a systematic literature review

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Abstract

Purpose

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 emergency setting. The present review critically summarizes currently available applications and limitations of indocyanine green (ICG) fluorescence in abdominal emergencies including acute cholecystitis, mesenteric ischemia, and trauma surgery.

Methods

A systematic review was performed according to the PRISMA statement identifying articles about the use of ICG fluorescence in the management of the most common general surgery emergency. Only studies focusing on the use of ICG fluorescence for the management of acute surgical conditions in adults were included.

Results

Thirty-six articles were considered for qualitative analysis. The most frequent disease was occlusive or non-occlusive mesenteric ischemia followed by acute cholecystitis. Benefits from using ICG for acute cholecystitis were reported in 48% of cases (clear identification of biliary structures and a safer surgical procedure). In one hundred and twenty cases that concerned the use of ICG for occlusive or non-occlusive mesenteric ischemia, ICG injection led to a modification of the surgical decision in 44 patients (36.6%). Three studies evaluated the use of ICG in trauma patients to assess the viability of bowel or parenchymatous organs in abdominal trauma, to evaluate the perfusion-related tissue impairment in extremity or craniofacial trauma, and to reassess the efficacy of surgical procedures performed in terms of vascularization. ICG injection led to a modification of the surgical decision in 50 patients (23.9%).

Conclusion

ICG fluorescence is a safe and feasible tool also in an emergency setting. There is increasing evidence that the use of ICG fluorescence during abdominal surgery could facilitate intra-operative decision-making and improve patient outcomes, even in the field of emergency surgery.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. UOC Chirurgia d’Urgenza E del Trauma, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Pietro Fransvea, Valeria Fico, Giuseppe Brisinda & Gabriele Sganga

  2. Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168, Rome, Italy

    Pietro Fransvea, Caterina Puccioni, Luca D’Agostino, Alberto Biondi, Giuseppe Brisinda & Gabriele Sganga

  3. Colorectal Surgery Clinical and Research Unit Surgery Center, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy

    Gianluca Costa

  4. General Surgery Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168, Rome, Italy

    Alberto Biondi

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Fransvea P. Study conception and design, literature search, acquisition, interpretation and analysis of data, drafting and critically revising the article for important intellectual content and final approval of the version to be published. Fico V. literature search, acquisition, interpretation and analysis of data. D’Agostino L. Literature search, acquisition, interpretation and analysis of data. Costa G. Literature search, acquisition, interpretation and analysis of data. Puccioni C. Literature search, acquisition, interpretation and analysis of data. Biondi A. Literature search, acquisition, interpretation and analysis of data. BG.,GS. Drafting and critically revising the article for important intellectual content and final approval of the version to be published. Sganga G Drafting and critically revising the article for important intellectual content and final approval of the version to be published.

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Fransvea, P., Fico, V., Puccioni, C. et al. Application of fluorescence-guided surgery in the acute care setting: a systematic literature review. Langenbecks Arch Surg 408, 375 (2023). https://doi.org/10.1007/s00423-023-03109-7

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