Green Eyes: The Head-to-toe Role of Indocyanine Green Fluorescence in General Surgery

Background: Indocyanine green (ICG) fluorescence imaging has recently emerged as a valuable adjunct in intraoperative visualization and anatomical identification.Owing to its relative inertness and favorable safety profile, ICG can be administered across a broad spectrum of patients and surgical procedures.Objective: This review aims to highlight the diverse applications of ICG fluorescence imaging in general surgery at a tertiary care center in Central India.Patients and methods: We describe our institutional experience with the intraoperative use of ICG fluorescence across multiple surgical subspecialties.Applications included endocrine, breast, and gastrointestinal surgeries, with ICG utilized for real-time assessment of anatomy, vascularity, and lymphatic mapping.Results: Indocyanine green fluorescence was successfully employed for visualization of parathyroid glands during neck surgeries, reverse axillary lymph node mapping in breast surgery, and in various gastrointestinal procedures.These included assessment of gastric conduit vascularity during esophagectomy, identification of vascular structures during median arcuate ligament syndrome (MALS) release, guidance during laparoscopic cholecystectomy, and visualization of ureters.Intraoperative use of ICG facilitated enhanced delineation of vital structures and real-time assessment of tissue perfusion.Conclusion: Based on our experience, ICG fluorescence imaging is a valuable and versatile tool in general surgery.Its use significantly aids intraoperative decision-making by improving anatomical visualization, ensuring adequate vascularity, and potentially reducing procedure-related complications.