https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Indocyanine Green (ICG) is a fluorophore commonly used in minimally invasive surgery for tissue visualization under near-infrared (NIR) fluorescence imaging. It is highly effective for localizing the ureter during complex surgeries. Here's how you can use it:<br /><br />Preparation<br />ICG Preparation:<br /><br />Dissolve ICG in sterile water or saline (recommended concentration: 2.5 mg/mL).<br />Ensure the ICG solution is fresh to maintain its fluorescence properties.<br />Equipment Setup:<br /><br />Use laparoscopic or robotic equipment equipped with NIR fluorescence imaging capability (e.g., Firefly in da Vinci systems or other fluorescence imaging scopes).<br />Patient Preparation:<br /><br />Insert a ureteral catheter if necessary, which can help in targeted delivery of ICG.<br />Confirm absence of allergy to iodine or ICG in the patient.<br />Procedure<br />1. Intravenous Administration<br />Administer ICG intravenously (dose: 0.25–0.5 mg/kg) approximately 5–10 minutes before imaging.<br />Wait for the ICG to circulate and selectively highlight the ureters due to its excretion by the kidneys.<br />2. Direct Ureteral Instillation (Optional)<br /><br />If more precise localization is needed, instill a diluted ICG solution directly into the ureter through a catheter. This method allows specific highlighting of the ureter.<br />3. Imaging and Localization<br />Switch to the NIR mode on your laparoscopic or robotic system.<br />Observe the ureter fluorescing green, which stands out clearly against non-fluorescent surrounding tissues.<br />Follow the fluorescence to trace the course of the ureter and avoid inadvertent injury during dissection.<br />Tips for Optimal Results<br />Timing:<br /><br />Ensure sufficient time for ICG to reach the ureter post-intravenous injection. This may vary based on renal function.<br />Avoid Overloading:<br /><br />Excessive ICG doses can result in background fluorescence, reducing contrast.<br />Monitor Renal Function:<br /><br />In cases of renal insufficiency, excretion and fluorescence may be delayed or reduced.<br />Enhance Visualization:<br /><br />Use minimal lighting in the NIR mode to enhance contrast.<br />Complementary Techniques:<br /><br />Combine ICG imaging with preoperative imaging (CT/MRI) and intraoperative landmarks for precise localization.<br />Applications<br />Pelvic Surgery: Localization of ureters in oncologic or endometriotic surgeries.<br />Ureterolysis: During complicated dissection.<br />Minimizing Ureteral Injury: Particularly in gynecological and colorectal procedures.<br />Using ICG for ureter localization is a safe and efficient technique that enhances surgical precision and minimizes complications.
