Advances in Fluorescent Adjuncts in Pediatric Surgery: A Comprehensive Review of Applications of Indocyanine Green Across Surgical Specialties

Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used more commonly in the adult population, its adoption in pediatric surgery has been increasing more frequently. This comprehensive review aims to elucidate the myriad of ICG surgical applications within the pediatric population and important clinical considerations for administration. Methods: PubMed was queried for pediatric surgical applications of indocyanine green. Surgical application, route of administration, dosage, ICG-related complications, and surgical impact of ICG fluorescence were analyzed. Results: In the pediatric population, ICG is used in a multitude of hepatobiliary, gastrointestinal, cardiothoracic, lymphatic, urologic, gynecologic, plastic, ENT, ophthalmologic, and neurosurgical procedures. Applications range from oncologic resections to benign and congenital reconstructions. Administration can be intravenous, intralesional, subcutaneous, inhaled, or enteric. Timing, dosage, and route of administration are dependent on the pathology of interest. Conclusions: ICG is a safe and useful adjunct for a wide variety of pediatric surgical applications. This comprehensive review aims to highlight administration considerations and the efficacy of ICG fluorescence in various surgical subspecialty pathologies. Future studies should continue to focus on how to integrate pathology-specific ICG fluorescence into intraoperative decision-making.