Question

ICG (Indocyanine Green) in surgical gastroenterology:
Write detailed notes about any two areas of use of ICG in surgery for surgical gastroenterology diseases.

Hint:

ICG is invaluable in liver and colorectal surgeries, providing real-time visualization of blood flow and tissue viability to guide surgical decisions and improve patient outcomes.

Answer 1

ICG has found several applications in surgical gastroenterology, improving surgical outcomes and reducing complications by providing enhanced visualization of key anatomical structures. Here, we will discuss two prominent areas of its use: liver surgery and colorectal surgery.
Step 1: ICG in Liver Surgery:
- Liver Perfusion Assessment: During liver surgeries such as hepatectomy or liver transplantation, ICG is used to assess the perfusion and viability of liver tissue. By injecting ICG intravenously, surgeons can observe the fluorescence of liver parenchyma and identify well-perfused areas, allowing for more precise tissue resection and minimizing the risk of leaving behind non-viable tissue.
- Identification of Critical Structures: ICG can also be used to highlight the biliary ducts, vascular structures, and tumors in the liver. This is particularly important in complex liver surgeries, where the identification of key structures is critical for reducing complications like bile duct injuries or hemorrhage.
Step 2: ICG in Colorectal Surgery:
- Assessment of Colorectal Blood Flow: In colorectal surgeries, especially during procedures such as bowel resections for cancer, ICG is used to assess the blood supply to the colon and rectum. By injecting ICG and using near-infrared cameras, surgeons can visualize the blood flow and determine if the remaining bowel tissue has adequate perfusion, thereby reducing the risk of anastomotic leakage or bowel necrosis.
- Guiding Anastomosis: ICG is also used to evaluate the viability of tissues after anastomosis (the surgical joining of two bowel ends). This ensures that the tissues have good blood supply, which is vital for healing and preventing complications such as leakage at the anastomotic site.