Oncologic rationale of ICG use in a general surgery department - Perfusion assessment, sentinel lymph node mapping and liver tumor identification

Oncologic rationale of ICG use in a general surgery department - Perfusion assessment, sentinel lymph node mapping and liver tumor identification

M. Misca¹, R. Boanta¹, S. Petrea*¹, S. Aldoescu¹, E. Catrina¹, M. Vilcu¹, V. Grigorean¹, V. Strambu¹, I. Brezean¹

1. General Surgery Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest

*Correspondence to: S. Petrea. General Surgery Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest

Copyright
© 2026  S. Petrea, is an open access article distributed under the Creative Commons Attribution   License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 29 April 2026

      Published: 12 May 2026

      DOI: https://doi.org/10.5281/zenodo.20137140

Abstract

Introduction: Over the past decade, fluorescence-guided surgery has seen an incredible surge in technical development and operating-room application, with surgeons trying to bridge the gap between the “seen” and the “unseen” oin an effort to improve surgical accuracy and structure identification. This study reports five years of institutional experience with indocyanine green (ICG) near infrared fluorescence guidance across abdominal and oncologic procedures, summarizing technical principles, clinical applications, and implementation practices.

Material and Methods: A prospectively documented cohort of 200 procedures included 50 colorectal perfusion assessments, 78 breast sentinel node mappings and a range of hepatic, gynecologic, and emergency cases. Methods and instrumentation were aligned with contemporary practice: intravenous angiography doses commonly ranged 0.1–0.5 mg/kg (frequently 0.2–0.25 mg/kg for bowel assessment), hepatic tumor imaging used 0.5 mg/kg preoperatively, and lymphatic injections employed submucosal/subserosal or intradermal routes with distilled water solution dilutions as indicated.

Results: Findings synthesize institutional outcomes with published syntheses showing lower anastomotic leak rates and improved sentinel node detection when fluorescence guidance is applied, especially in colorectal and gynecologic settings. ICG proved safe with no documented adverse reactions and high sensitivity for detection of subcapsular liver lesions. Operational lessons emphasize standardized dosing, calibrated imaging modes, routine video capture, team training, and transparent reporting principles.

Conclusion: Recommendations prioritize harmonized protocols and prospective, preregistered evaluations to enable generalizable assessment of clinical benefit. In conclusion, we believe that introduction of fluorescence-guided techniques with ICG in oncologic surgery can improved surgical accuracy, outcomes and patient benefit, as well as increasing surgeon comfort in complex procedures.

Introduction

Fluorescence guidance with indocyanine green (ICG) has emerged as a central adjunct in modern oncologic and gastrointestinal surgery, building on the physical property of the dye to emit near infrared light after excitation at wavelengths between 700 and 900 nm. Once injected, ICG binds to plasma proteins and becomes visualizable in the bloodstream with dedicated ICG/near infrared imaging systems that are integrated into standard high definition laparoscopic and robotic platforms and coupled to a xenon cold light source. This configuration permits real time visualization of vascularized structures without altering the conventional operative workflow.(1)

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