Revisión sistemáticaGuía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experienciaIndocyanine green (ICG) fluorescence guide for the use and indications in general surgery: Recommendations based on the descriptive review of the literature and the analysis of experience
Graphical abstract
Section snippets
Introducción
La fluorescencia es una luminiscencia que caracteriza a las sustancias que son capaces de absorber energía en forma de radiaciones electromagnéticas, para posteriormente emitir parte de esa energía en forma de dicha radiación, pero de longitud de onda diferente1.
El verde de indocianina (indocyanine green [ICG]) es una tinción tricarbocianida fluorescente visible con luz cercana al infrarrojo (near infra-red [NIR]) o por sistemas láser, que fue aprobada por la Food and Drug Administration en 1956
Preparación del verde de indocianina
El ICG se administra usualmente diluido con agua destilada3, 6, 9, 10, 11, 12. En caso de que su utilización sea para identificar el ganglio linfático centinela de drenaje de un tumor, el ICG se diluye con albúmina9, 10. El objetivo de su uso con albúmina viene determinado por su capacidad de detenerse en ese primer ganglio de drenaje y poderse identificar adecuadamente9, 10. Este medicamento no debe diluirse con soluciones salinas (suero fisiológico, solución de Ringer), ya que podrían
Vía biliar
La fluorescencia con ICG permite realizar una colangiografía virtual a tiempo real intraoperatoria durante la colecistectomía laparoscópica y evitar situaciones de potencial riesgo de lesión de la vía biliar13, 14, 17, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47.
El ICG, al concentrarse a nivel hepático y excretarse por la bilis, hace posible que se dibuje la anatomía del árbol biliar13, 14, 17, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47. El uso del ICG
Valoración de la perfusión de tejidos
La valoración de la vascularización de los tejidos para realizar una anastomosis ha sido demostrada en distintas áreas de la cirugía general66, como la cirugía colorrectal3, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, esofágica86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, gástrica98, 99 y bariátrica100, 101. Además, su uso se ha expandido para establecer la necesidad de realizar una resección intestinal en hernias estranguladas102, 103, 104, 105, 106 o valorar
Tumores primarios de hígado y metástasis hepáticas
La fluorescencia con ICG permite la identificación de las lesiones hepáticas128, 129, 130, 131, 132, 133, 134, 135, 136. El tejido hepático sano elimina el ICG en un plazo de 2 h, mientras el tejido peritumoral lo podría retener por la compresión que se produce en los conductos biliares por el propio tumor, marcando un halo que permite identificar la lesión y marcar los límites de resección, circunstancia que se observa en las metástasis hepáticas128, 129, 135. Por su parte, el carcinoma
Ganglio centinela
El ICG para la identificación del ganglio centinela en cirugía oncológica está encontrando un importante desarrollo con la idea de realizar una cirugía conservadora y evitar linfadenectomías extensas cuando no son necesarias, teniendo un gran desarrollo en cirugía del cáncer gástrico157, 158, 159 y de la mama160, 161, 162, 163.
Conclusiones
La fluorescencia con ICG es una tecnología muy útil en cirugía general. Existen suficientes evidencias que ponen de relieve que el empleo de ICG es un recurso seguro, sencillo y fácil de manejar, que resulta muy útil en el reconocimiento de estructuras anatómicas, vascularización de tejidos, tumores y ganglios linfáticos. Las dosis de uso y el modo de empleo es variable de unos grupos a otros, existiendo aún poco consenso en este sentido, fundamentalmente basado en si se deben usar dosis fijas
Contribuciones de los autores
Salvador Morales-Conde: diseños de estudio, adquisición de datos, análisis e interpretación de resultados, preparación del manuscrito, revisión crítica y aprobación de la versión final del manuscrito.
Eugenio Licardie: diseños de estudio, adquisición de datos, análisis e interpretación de resultados, preparación del manuscrito, revisión crítica y aprobación de la versión final del manuscrito.
Isaias Alarcón: diseños de estudio, adquisición de datos, análisis e interpretación de resultados,
Conflicto de intereses
Salvador Morales-Conde, Eugenio Licardie, Isaias Alarcón y Andrea Balla no tienen conflictos de intereses o vínculos financieros que revelar.
Bibliografía (186)
- et al.
A review of NIR dyes in cancer targeting and imaging
Biomaterials.
(2011) - et al.
The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer
J Gastrointest Surg.
(2019) - et al.
A comparison of indocyanine green fluorescence and laparoscopic ultrasound for detection of liver tumors
HPB (Oxford).
(2020) - et al.
A novel color-coded liver metastasis mouse model to distinguish tumor and adjacent liver segment
J Surg Res.
(2021) - et al.
Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography
Surv Ophthalmol.
(2000) - et al.
Safe laparoscopic cholecystectomy: A systematic review of bile duct injury prevention
Int J Surg.
(2018) - et al.
Laparoscopic fluorescence navigation for left-sided colon and rectal cancer: Blood flow evaluation, vessel and ureteral navigation, clip marking and trans-anal tube insertion
Surg Oncol.
(2020) - et al.
Autofluorescence imaging of parathyroid glands: Anassessment of potential indications
Surgery.
(2020) - et al.
Do near-infrared intra-operative findings obtained using indocyanine green correlate with post-thyroidectomy parathyroid function? the Icgpredict Study
Endocr Pract.
(2020) - et al.
The impact of indocyanine-green fluorescence angiogram on colorectal resection
Surgeon.
(2019)
Indocyanine green tissue angiography affects anastomotic leakage after esophagectomy. A retrospective, case-control study
Int J Surg.
Indocyanine green fluorescence angiography for quantitative evaluation of gastric tube perfusion in patients undergoing esophagectomy
J Am Coll Surg.
Visualized evaluation of blood flow to the gastric conduit and complications in esophageal reconstruction
J Am Coll Surg.
Prospective evaluation of surgical microscope–integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery
J Neurosurg
Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection
Surg Endosc
The utilization of fluorescent cholangiography during robotic cholecystectomy at an inner-city academic medical center
J Robot Surg.
Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery
Br J Surg.
Sentinel node procedure of the sigmoid using indocyanine green: feasibility study in a goat model
Surg Endosc.
Near-infrared fluorescence imaging for sentinel lymph node identification in colon cancer: a prospective single-center study and systematic review with meta-analysis
Tech Coloproctol.
Identification of the lymphatic drainage pattern of esophageal cancer with near-infrared fluorescent imaging
J Laparoendosc Adv Surg Tech A.
Assessment of the completeness of lymph node dissection using near-infrared imaging with indocyanine green in laparoscopic gastrectomy for gastric cancer
J Gastric Cancer.
Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery
Surg Endosc.
Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry
Surg Endosc.
Quantitative assessment of visual estimation of the infrared indocyanine green imaging of lymph nodes retrieved at sentinel node navigation surgery for gastric cancer
BMC Surg.
Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer
World J Gastroenterol.
Direct gallbladder indocyanine green injection fluorescence cholangiography during laparoscopic cholecystectomy
J Laparoendosc Adv Surg Tech A.
Indocyanine green for intraoperative localization of ureter
Am J Obstet Gynecol.
Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging
J Biomed Opt.
Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage
Langenbecks Arch Surg.
Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINATM technology: preliminary experience in two pediatric surgery centers
Surg Endosc.
Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software-based algorithms for quantification
Surg Endosc.
Optimizing quantitative fluorescence angiography for visceral perfusion assessment
Surg Endosc.
Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review
Langenbecks Arch Surg.
Fluorescent imaging using indocyanine green during esophagectomy to prevent surgical morbidity: a systematic review and meta-analysis
J Thorac Dis.
A review of indocyanine green fluorescent imaging in surgery
Int J Biomed Imaging.
Quantification of fluorescence angiography in a porcine model
Langenbecks Arch Surg.
Application of indocyanine green in flap surgery: a systematic review
J Reconstr Microsurg.
Failure to integrate quantitative measurement methods of ocular inflammation hampers clinical practice and trials on new therapies for posterior uveitis
J Ocul Pharmacol Ther.
A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery
J Surg Oncol.
Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy
Surg Endosc.
Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy
Surg Endosc.
Fluorescence cholangiography during laparoscopic cholecystectomy: a feasibility study on early biliary tract delineation
Surg Endosc.
Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy
Surg Endosc.
Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison
Surg Endosc.
Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review
Surg Endosc.
Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial
Br J Surg.
Evaluation of laparoscopic cholecystectomy using indocyanine green cholangiography including cholecystitis: A retrospective study
Medicine (Baltimore).
Indocyanine green (ICG) fluorescent cholangiography during robotic cholecystectomy: results of 184 consecutive cases in a single institution
Surg Innov.
Randomized trial of near-infrared incisionless fluorescent cholangiography
Ann Surg.
Cited by (20)
Podophyllotoxin-loaded PEGylated E-selectin peptide conjugate targeted cancer site to enhance tumor inhibition and reduce side effect
2023, European Journal of Medicinal ChemistryUse of intraoperative indocyanine green fluorescence in determining testicular viability in testicular torsion patients in rural settings: A case report
2023, International Journal of Surgery Case ReportsA novel near-infrared EGFR targeting probe for metastatic lymph node imaging in preclinical mouse models
2023, Journal of Nanobiotechnology