Applications of indocyanine green (ICG) fluorescence technology in open surgery: preliminary experience in pediatric surgery

Ciro Esposito; Benedetta Lepore; Mariapina Cerulo; Fulvia Del Conte; Vincenzo Coppola; Giovanni Esposito; Roberto Carulli; Francesca Carraturo; Maria Escolino

doi:10.3389/fsurg.2023.1238487

Applications of indocyanine green (ICG) fluorescence technology in open surgery: preliminary experience in pediatric surgery

Front Surg. 2023 Aug 16:10:1238487. doi: 10.3389/fsurg.2023.1238487. eCollection 2023.

Authors

Ciro Esposito¹, Benedetta Lepore¹, Mariapina Cerulo¹, Fulvia Del Conte¹, Vincenzo Coppola¹, Giovanni Esposito², Roberto Carulli¹, Francesca Carraturo¹, Maria Escolino¹

Affiliations

¹ Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
² CEINGE Advanced Biotechnologies Center Franco Salvatore scarl, Naples, Italy.

Abstract

Background: Indocyanine green fluorescence technology (ICG) in pediatric minimally invasive surgery has undergone an important improvement in the last 5 years. However, its use in open surgery is still limited. In this paper, we aim to report our preliminary experience with Rubina® lens ICG fluorescence technology in combination with the IMAGE1 S™ system from KARL STORZ in open excision of masses in children.

Methods: The records of 18 patients undergoing open surgery for head, neck and thorax masses between September and November 2022 were retrospectively reviewed. Rubina® lens ICG fluorescence technology system was used in all the cases. In 10 cases we adopted the holding arm system and in 8 cases the hand-held technique. Data about patients' demographics, surgery and outcomes were collected and analyzed through the following criteria: mass localization, intraoperative time (min), ICG administration (ml), intraoperative complications, postoperative complications.

Results: A total of 18 patients were operated: 4 thyroglossal duct cysts, 3 supraorbital cysts, 2 neck masses, 2 pre-auricular and 2 scalp cysts, 2 gynecomastias, 2 lymphangiomas, 1 nose mass. In all the cases, intralesional injection of 0.5-1 ml of ICG solution was performed peri-operatively. Mean operative time was 58.4 min (35-134 min). Postoperative complications included seroma formation in 2 cases. Surgical pathology reports confirmed complete mass excision in all the cases.

Conclusion: Based on our preliminary experience, ICG fluorescence guided surgery using Rubina® lens system was very helpful also in open surgery procedures. Rubina® lens system permits to have a very low complication rate, a time-saving surgery, a real time reliability of anatomic structures and an excellent clinical safety. In our experience, holding arm system seems more comfortable than hand-held system. However, further cases need to be performed to evaluate the exact role and to identify new indications of this technique in open pediatric surgical procedures.

Keywords: ICG; children; fluorescence; nir; open surgery; rubina lens.