Advancing Pediatric Surgery with Indocyanine Green: Nonhepatobiliary Applications and Outcomes

ABSTRACT Aim: This prospective single-center study aimed to evaluate the nonhepatobiliary applications of indocyanine green fluorescence-guided surgery (ICG FGS) in pediatric patients, assessing its utility as an adjunct for intraoperative imaging. Materials and Methods: Over a 30-month period from January 2021 to July 2023, pediatric patients undergoing various surgical procedures, excluding hepatobiliary cases, were included in the study. ICG (Aurogreen™) was administered intravenously or directly injected in tissue, and fluorescence imaging was conducted using specialized equipment (KARL STORZ GmbH and Co. KG). Patient demographics, diagnoses, surgical procedures, ICG protocols, intraoperative findings, and perioperative outcomes were analyzed. Results: The study included seventeen pediatric cases including Hirschsprung disease, anorectal malformations, undescended testes, varicocele, Mayer-Rokitansky-Kustner-Hauser syndrome, ovarian torsion, chylous ascites, chylothorax, and Wilms’ tumor. ICG aided in the real-time assessment of vascular, intestinal perfusion in Hirschsprung disease, anorectal malformations, delineation of lymphatics from vessels in varicocele, confirmation of preserved vascularity after detorsion of ovary, identification of lymphatics for ligation in chylothorax, and chylous ascites. ICG thus aided in precise dissection and confirming tissue viability without reported adverse events. Conclusion: ICG FGS demonstrates significant potential as a tool for enhancing surgical outcomes in pediatric surgeries including indications beyond hepatobiliary cases. The findings suggest that ICG FGS can improve surgical precision by providing real-time assessment of tissue perfusion, and lymphatic mapping, thereby potentially reducing intraoperative complications. Further research and prospective studies are essential to validate its efficacy and establish standardized protocols, aiming to integrate ICG FGS as a routine adjunct in pediatric surgical practice.