Update Course Rewind: Updates in Indocyanine Green (ICG) 2023

Indocyanine Green was discovered by the post-World War II Kodak company and has been FDA approved since the 1960s.

ICG is a safe, harmless fluorescent contrast that can be injected subcutaneously or intravenously depending on the use.

ICG usage has really developed in hepatobiliary surgery.

Sentinel node biopsy at the time of port placement for alveolar rhabdomyosarcoma is pretty much standard of care.

Pediatric surgeons can consider use of ICG as an adjunct to sentinel node identification.

ICG can be used in the operating room with equipment that is either already present or about to be standard in all laparoscopic towers.

After indocyanine injection into the tumor, ICG travels to the sentinel node over the course of 45, 60, or 75 seconds.

ICG is exclusively biliary cleared.

For detecting liver tissue metastases in the chest, ICG should be given the day before surgery so it is the only thing left in the chest by the time of thoracotomy.

At the time of thoracotomies for lung metastases, if ICG is given the day before, additional metastases can be found beyond what is detected by palpation and visual inspection.

Spots detected by ICG in the chest after preoperative administration are also positive on histology.

Fluorescent ureteral stents that emit infrared light can be detected by standard laparoscopic systems and help protect ureters during pelvic tumor resection.

Fluorescent ureteral stents can enable minimally invasive approaches to cases that would otherwise require open surgery due to ureteral proximity to tumor.