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Applications of indocyanine green (ICG) fluorescence technology in open surgery: preliminary experience in pediatric
Ciro Esposito1, Benedetta Lepore1, Mariapina Cerulo1
1Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
Insights
Indocyanine green (ICG) fluorescence technology, when used with the Rubina® lens system, proves beneficial in pediatric open surgeries for mass excision. This technique offers reliable visualization, reduces complications, and saves time.
Area of Science:
- Pediatric Surgery
- Surgical Technology
- Medical Imaging
Background:
- Indocyanine green (ICG) fluorescence technology has advanced pediatric minimally invasive surgery.
- Its application in pediatric open surgery remains limited.
- This study explores the preliminary use of Rubina® lens ICG fluorescence technology with the IMAGE1 S™ system in open pediatric mass excisions.
Purpose of the Study:
- To evaluate the preliminary experience and efficacy of Rubina® lens ICG fluorescence technology in open pediatric mass excision.
- To assess the safety, reliability, and potential benefits of this technology in open surgical procedures for children.
Main Methods:
- Retrospective review of 18 pediatric patients undergoing open surgery for head, neck, and thorax masses.
- Utilized Rubina® lens ICG fluorescence technology with IMAGE1 S™ system.
- Compared holding arm system (10 cases) versus hand-held technique (8 cases).
Main Results:
- 18 pediatric patients with various masses (thyroglossal duct cysts, neck masses, lymphangiomas, etc.) were included.
- Complete mass excision was confirmed in all cases.
- Mean operative time was 58.4 minutes; postoperative seroma formation occurred in 2 cases.
Conclusions:
- ICG fluorescence-guided surgery with the Rubina® lens system is effective in pediatric open surgery.
- The technology offers low complication rates, time savings, and reliable visualization of anatomical structures.
- Further research is needed to define its exact role and identify new indications in pediatric open surgery.
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.
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