Novel Intraoperative Applications of Fluorescence Imaging Using Indocyanine Green in Pediatric Urology

Near-infrared fluorescence imaging (NIRF) with the use of indocyanine green (ICG) has been recently adopted in pediatric urology after its well-published use in the adult population. As a powerful tool that can help delineate complex anatomy and congenital anomalies, we discuss the various applications of this imaging in minimally invasive and open surgery in pediatric urology.

The most reported applications of ICG in pediatric urology are within minimally invasive surgery, particularly varicoceles, renal surgery such as nephrectomies and renal tumor excision, mimicking its use in adult urology. ICG has also been applied to reconstructive urology such as ureteral reconstruction, hypospadias repair and bladder exstrophy. Despite its safety and more widespread use in pediatric surgery, all published studies in pediatric urology to date have been limited to small and single-center experiences, reflecting the novel nature of this technology in this field. ICG has been shown to be safe and effective in children, particularly in those with complex anatomy and in technically challenging surgeries. Future studies should focus on standardized protocols for children and multi-center comparative studies.