Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper

被引：0

作者：

De Simone, Belinda ^{[1
,2
]}

Abu-Zidan, Fikri M. ^{[3
]}

Boni, Luigi ^{[4
]}

Castillo, Ana Maria Gonzalez ^{[5
]}

Cassinotti, Elisa ^{[4
]}

Corradi, Francesco ^{[6
]}

Di Maggio, Francesco ^{[7
]}

Ashraf, Hajra ^{[7
]}

Baiocchi, Gian Luca ^{[8
]}

Tarasconi, Antonio ^{[9
]}

Bonafede, Martina ^{[9
]}

Truong, Hung ^{[10
]}

De'Angelis, Nicola ^{[11
]}

Diana, Michele ^{[12
,13
]}

Coimbra, Raul ^{[14
]}

Balogh, Zsolt J. ^{[15
,16
]}

Chouillard, Elie ^{[17
]}

Coccolini, Federico ^{[18
]}

Kelly, Micheal Denis ^{[19
]}

Di Saverio, Salomone ^{[20
]}

Di Meo, Giovanna ^{[21
]}

Isik, Arda ^{[22
]}

Leppaeniemi, Ari ^{[23
,24
]}

Litvin, Andrey ^{[25
]}

Moore, Ernest E. ^{[26
]}

Pasculli, Alessandro ^{[21
]}

Sartelli, Massimo ^{[27
]}

Podda, Mauro ^{[28
]}

Testini, Mario ^{[21
]}

Wani, Imtiaz ^{[29
]}

Sakakushev, Boris ^{[30
]}

Shelat, Vishal G. ^{[31
]}

Weber, Dieter ^{[32
]}

Galante, Joseph M. ^{[33
]}

Ansaloni, Luca ^{[34
]}

Agnoletti, Vanni ^{[35
]}

Regimbeau, Jean-Marc ^{[36
]}

Garulli, Gianluca ^{[1
]}

Kirkpatrick, Andrew L. ^{[37
,38
]}

Biffl, Walter L. ^{[39
]}

Catena, Fausto ^{[40
,41
]}

机构：

[1] AUSL Romagna, Infermi Hosp, Dept Emergency & Gen Minimally Invas Surg, Rimini, Italy

[2] eCampus Univ, Dept Theoret & Appl Sci, Novedrate, CO, Italy

[3] United Arab Emirates Univ, Coll Med & Hlth Sci, Dept Surg, Al Ain, U Arab Emirates

[4] Fdn IRCCS CaGranda Osped Maggiore Policlin Milano, Dept Gen & Minimally Invas Surg, Milan, Italy

[5] Hosp Mar Univ Pompeu Fabra, Hepatobiliary & Pancreat Surg Unit, Barcelona, Spain

[6] Univ Pisa, Dept Surg Med & Mol Pathol & Crit Care Med, Pisa, Italy

[7] Croydon Univ Hosp, Dept Gen Surg, Upper Gastrointenstinal Surg Unit, London, England

[8] Univ Brescia, Dept Clin & Expt Sci, Unit Gen Surg, Brescia, Italy

[9] ASST Cremona, UOC Gen Surg, Cremona, Italy

[10] Scripps Mem Hosp La Jolla Green & Encinitas, Eye Care La Jolla, La Jolla, CA USA

[11] Ferrara Univ Hosp, Unit Robot & Minimally Invas Digest Surg, Ferrara, Italy

[12] Univ Hosp Geneva, Dept Surg, CH-1205 Geneva, Switzerland

[13] ICube Lab, Dept Elect Solid Syst & Photon, F-67034 Strasbourg, France

[14] Riverside Univ Hlth Syst, Med Ctr, Riverside, CA USA

[15] John Hunter Hosp, Dept Traumatol, Newcastle, NSW, Australia

[16] Univ Newcastle, Newcastle, NSW, Australia

[17] Amer Hosp Paris, Dept Odontol, Paris, France

[18] Univ Hosp Pisa, Dept Gen Surg, Pisa, Italy

[19] MedAlliance, Albury, NSW, Australia

[20] AST Ascoli Piceno, Madonna del Soccorso Hosp, Gen Surg Unit, San Benedetto Tronto, Italy

[21] Univ Bari A Moro, Dept Precis & Regenerat Med, Pediat Unit, Bari, Italy

[22] Istanbul Medeniyet Univ, Istanbul, Turkiye

[23] Helsinki Univ Hosp, Div Emergency Surg, Helsinki, Finland

[24] Univ Helsinki, Helsinki, Finland

[25] Gomel State Med Univ, Dept Surg Dis 3, Univ Clin, Gomel, BELARUS

[26] Univ Colorado, Ernest E Moore Shock Trauma Ctr Denver Hlth, Denver, CO USA

[27] Macerata Hosp, Dept Gen Surg, Macerata, Italy

[28] Univ Cagliari, Dept Surg Sci, Unit Emergency Surg, Cagliari, Italy

[29] DHS Hosp, Dept Surg, Srinagar, Kashmir, India

[30] Med Univ Plovdiv, St George Univ Hosp, Univ Hosp St George, Plovdiv, Bulgaria

[31] Tan Tock Seng Hosp, Dept Gen Surg, Novena, Singapore

[32] Univ Western Australia, Royal Perth Hosp, Dept Gen Surg, Perth, WA, Australia

[33] Univ Calif Davis, UC Davis Hlth, Davis, CA USA

[34] Univ Pavia, Dept Gen Surg, Pavia, Italy

[35] AUSL Romagna, Bufalini Hosp, Level Trauma Ctr 1, Cesena, Italy

[36] CHU Sud, CHU Amiens, Serv Chirurg Digest, Ctr Hosp Univ Amiens Picardie Site Sud, F-80054 Amiens, France

[37] Univ Calgary, Foothills Med Ctr, Dept Crit Care Med, Calgary, AB, Canada

[38] Univ Calgary, Foothills Med Ctr, Dept Surg, Calgary, AB, Canada

[39] Scripps Clin Med Grp, Div Trauma Acute Care Surg, La Jolla, CA USA

[40] Bufalini Hosp Level 1 Trauma Ctr, Dept Gen & Emergency Surg, AUSL Romagna, Cesena, Italy

[41] Univ Bologna, Alma Mater Studiorum, Bologna, Italy

来源：

WORLD JOURNAL OF EMERGENCY SURGERY | 2025年 / 20卷 / 01期

关键词：

Fluorescence; Angiography; Cholangiography; Emergency; Surgery; Precision; Indocyanine green; World society of emergency surgery; Artificial intelligence; Technology; Practice; Modern surgery; NONOCCLUSIVE MESENTERIC ISCHEMIA; BILE-DUCT INJURY; PLASMA DISAPPEARANCE RATE; ASSESS BOWEL PERFUSION; BLOOD-FLOW ASSESSMENT; LAPAROSCOPIC CHOLECYSTECTOMY; COLORECTAL SURGERY; ENHANCED FLUORESCENCE; RISK-FACTORS; INTRAOPERATIVE CHOLANGIOGRAPHY;

D O I：

10.1186/s13017-025-00575-w

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundDecision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient's risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries.AimThis consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings.MethodsUsing the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval.ResultsICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5-10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection.ConclusionsAdvanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures-areas traditionally reliant on the surgeon's visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures.

引用

页数：35

共 137 条

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