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Updated: Jan 12, 2026
Application of Indocyanine Green Fluorescence Imaging Technology in Laparoscopic Duodenum-Preserving Pancreatic Head Resection
Published on: November 21, 2025
SAGES 2025 systematic review and meta-analysis for fluorescence image-guided gastrointestinal surgery using
Panagiotis Kapsampelis1, Elisa C Calabrese2,3,4, Sunjay S Kumar5
1Leeds Institute of Emergency General Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Background:
Fluorescence image-guided surgery (FIGS) using indocyanine green (ICG) enhances intraoperative visualization. Its application spans various surgical fields, yet evidence on its influence on clinical outcomes remains inconsistent. This systematic review was conducted as part of a guideline development process to evaluate the effectiveness of FIGS with ICG across several different surgical applications.
Methods:
A systematic review was carried out, including a literature search up to October 2022, addressing eight predefined key questions (KQs) on the role FIGS with ICG in thoracic duct identification, detection of distant cancer metastases and primary cancers, lymph node retrieval, and improved evaluation of anastomotic perfusion. The search was extended until September 2024 for colorectal anastomosis application. Eligible studies included randomized controlled trials (RCTs) and comparative observational studies. Meta-analyses were conducted where appropriate. The review is reported following PRISMA 2020 guidelines.
Results:
Seven RCTs were pooled and found that FIGS with ICG reduced colorectal anastomotic leak rates (Odds Ratio (OR) 0.58, 95%CI 0.44-0.75). It also facilitated intraoperative changes in the transection point during colorectal anastomoses in RCTs (OR 35.15, 95%CI 8.72-141.77). FIGS with ICG increased lymph node retrieval in gastrointestinal cancer surgeries by 6.32 nodes on average (95%CI 4.43-8.22). Evidence regarding its role in thoracic duct identification, esophageal anastomoses, bariatric surgeries, and pediatric applications remained limited.
Conclusions:
This systematic review demonstrates that FIGS with ICG improves outcomes in specific surgical applications, particularly in malignant lymph node retrieval and colorectal anastomotic leak reduction. However, its effectiveness varies depending on the surgical context and clinical question. Further high-quality studies are required to address remaining gaps and inform evidence-based guidelines for broader implementation.
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