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This article is a highlight of the paper by Huang et al. in this issue of Photochemistry and Photobiology. It describes shades of phototoxicity in fluorescent imaging agents that are not intended to be phototoxic. Phototoxicity was assessed using a modified neutral red uptake (NRU) in vitro assay with mean photo‐effects (MPE) for the fluorescent agents IRdye800, indocyanine green (ICG), proflavine, and methylene blue (MB), with comparisons to known phototoxic agents benzoporphyrin derivative (BPD) and rose bengal (RB). The experimental conditions were aimed to mimic clinical settings, using not only visible light, but also near‐infrared light for insight to photosafety and deep tissue damage. Molecular mechanisms underlying the phototoxicities were not sought, but IRdye800 and ICG were mainly deemed to be safe, whereas proflavine and MB would require precautions since phototoxicity can overshadow their utility as fluorescent imaging agents. [ABSTRACT FROM AUTHOR]

Aim: Gender dysphoria is the disagreement between the gender of birth and the one with which the patient identifies. For its management it is mandatory to have a multidisciplinary team. Gender confirmation surgery with penoscrotal skin flap is the procedure of choice, and a sigmoid vaginoplasty is a feasible alternative. The new technologies and the help of indocyanine green (ICG) fluorescence can help to guarantee a correct neovagina vascularization. The objective of this paper is to present the surgical technique of laparoscopic sigmoid vaginoplasty assisted by ICG. Methods: We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement. Results: Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications. Conclusion: Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina. [ABSTRACT FROM AUTHOR]

Indocyanine green is a great near-infrared fluorescence with good luminescent properties and important medical applications. In this paper, the theoretical spectrum and orbital model of its molecular level are established. The two most probable conformations were studied, and their energies, vibrational spectra, UV-Vis absorption spectra, frontier molecular orbitals (HOMO and LUMO), and energy gaps were obtained by density functional theory (DFT) calculations, respectively. This provides a theoretical and design basis for the development of novel dyes similar to indocyanine green dyes and a reference case for improved application methods and synthetic predesign of novel fluorescent dyes. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

This article describes a video endoscopy system intended for fluorescence‐based imaging of the tracheobronchial tree in the visible (VIS) and near‐infrared (NIR) regions of the spectrum. This system helps acquire both fluorescence images (VIS/NIR) and a white‐light image of the same area and has been developed on the basis of a standard bronchofiberscope with several diode lasers used as the light sources to excite Vis and NIR, the white‐light source, and photodynamic irradiation. A multimodal video system forms images and gives the possibility to perform targeted photodynamic therapy and control the dose of light irradiation through assessing the degree of photobleaching.The system capability is illustrated through clinical examples. The paper describes the procedure for photodynamic theranostics with chlorin e6 in patients with central lung cancer. The possibility of additional accurate localization of tumor lesions and their borders with NIR imaging is shown; to acquire a NIR image, a common dose of indocyanine green (ICG) used in angiography was administered to patients during the examination. It is also demonstrated that the same lesions can be identified using a combination of two dyes: chlorin e6 + ICG. [ABSTRACT FROM AUTHOR]

Aim: Several papers have shown that use of indocyanine green (ICG) decreases incidence of anastomotic leakage (AL) during colonic surgery, but no clear evidence has been found for rectal cancer surgery. Therefore, with this systematic review and meta‐analysis of randomized controlled trials (RCTs) we aimed to assess if ICG could also reduce risk of AL in rectal cancer surgery. Method: PubMed, Scopus, CINAHL and Cochrane databases were searched for RCTs assessing the effect of intraoperative ICG on the incidence of AL of the colorectal anastomosis. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Risk of bias was evaluated with the Rob2 tool and the quality of evidence was assessed using the GRADE Pro tool. Results: Four RCTs were included for analysis, with a total of 1510 patients (743 controls and 767 ICG patients). The rate of AL was 9% in the ICG group (69/767) and 13.9% (103/743) in the control group (p = 0.003, RR −0.5, 95% CI −0.827 to −0.172, heterogeneity test 0%, p = 0.460). The RD in terms of incidence of AL was significantly decreased by 4.51% (p = 0.031, 95% CI −0.086 to −0.004, heterogeneity test 28%, p = 0.182) when using ICG. Conclusion: Our meta‐analysis suggested that use of ICG during rectal cancer surgery could reduce the rate of AL. [ABSTRACT FROM AUTHOR]

Background and aims Anastomotic dehiscence is one of the most feared complications in colorectal surgery leading to significant morbidity and mortality. Progressively lower anastomoses are associated with a greater leak rate. One of the key factors is the perfusion of the bowel to be joined. Presently, surgeons rely on a variety subjective measures to determine anastomotic perfusion and mechanical integrity however these have shortcomings. The aim of this paper is to appraise the literature on the use of fluorescence angiography ( FA) in laparoscopic rectal surgery. Materials and methods A Pubmed search was undertaken using terms 'fluorescence angiography' and 'rectal surgery'. The search was expanded using the related articles function. Studies were included if they used FA specifically for rectal surgery. Outcomes of interest including anastomotic leak rate, change of operative strategy and time taken for FA were recorded. Results Eleven papers detailing the use of FA in rectal surgery are outlined demonstrating that this technique may change operative strategy and lead to a reduction in anastomotic leak rate. Conclusion In this paper, we discuss assessment of colorectal blood supply using FA and how this technique holds great potential to detect insufficiently perfused bowel. In so doing, the operator can adjust their operative strategy to mitigate these affects with the aim of reducing the complications of anastomotic leak and stenosis. However, it is highlighted that there is a clear need for randomised controlled trials in order to determine this definitively. [ABSTRACT FROM AUTHOR]

Introduction: Endometriosis is a very common disease that affects up to 10% of the female population. The use of indocyanine green (ICG) dye has been proposed to allow the proper localization of endometriotic lesions during surgery. Our purpose is to offer an overview of near‐infrared (NIR)‐ICG in the surgical treatment of superficial peritoneal endometriosis and deep infiltrating endometriosis. Material and methods: Electronic databases were searched, including MEDLINE, Embase, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library. The studies were identified with the use of a mesh combination of the following keywords: "indocyanine green", "endometriosis", "deep endometriosis", "robotic surgery", "laparoscopy", "ureter", "rectosigmoid" from 2000 to May 2020. All articles describing the use of ICG applied to endometriosis surgery were considered for review. Only original papers that reported specific experience data on the topic were included. Moreover, video‐articles were included in the analysis. Quality and risk of bias were evaluated by two authors, respectively. Results: Fifty‐three studies were reviewed and reviews or comment articles not reporting original data and original articles lacking specific data on the application of ICG in patients affected by endometriosis were excluded. The quality of the 17 studies included was assessed. Eight studies suggested the usefulness of NIR‐ICG as a tool in the detection of endometriosis during surgery, and one randomized controlled trial and one prospective study did not confirm the advantage of its use. Eight studies found that NIR‐ICG was useful for the evaluation of vascularization in intestinal anastomoses and ureterolysis after surgery for deep infiltrating endometriosis. Conclusions: NIR‐ICG appears useful in the evaluation of vascularization in intestinal anastomoses after segmental resection, confirming its role even after ureterolysis for parametrial deep infiltrating endometriosis. However, its usefulness as a tool in the detection of endometriosis during surgery is inconsistent. [ABSTRACT FROM AUTHOR]

Objectives: This study assesses the safety and efficacy of using indocyanine green (ICG) for preoperative CT‐guided localization of multiple pulmonary nodules. Methods: We included patients who underwent CT‐guided preoperative ICG localization followed by video‐assisted thoracoscopic surgery (VATS). Four primary outcomes were evaluated: technical success, pneumothorax, pulmonary hemorrhage, and postoperative hospital stay (PHS). Patients were classified into single nodule and multiple nodules groups, with further subgroups based on the side of localization including unilateral and bilateral subgroups. Univariate and multivariate analyses were used to evaluate risk factors for PHS and pneumothorax. Results: A total of 374 patients (54.8 ± 11.4 years, 99 with multiple nodules). The success rate in the multiple nodules group was 98.3%, similar to single nodules. Apart from PHS, no significant differences were observed in outcomes between patients with single and multiple nodules. Longer PHS was observed for patients with multiple nodules (3 [2–4] days vs. 3 [3–4] days, p = 0.022). Multivariable analysis indicated longer stays were associated with pulmonary hemorrhage during localization, surgical blood loss, postoperative complications, and non‐segmentectomy procedures. Advanced age emerged as the sole independent risk factor for pneumothorax. The success rate in the unilateral subgroup and the bilateral subgroup was 97.8% and 99%, respectively, with higher pneumothorax rates in the unilateral subgroup (38.3% vs. 20%). Conclusion: CT‐guided preoperative ICG localization of multiple pulmonary nodules is safe and effective. It can be applied to both unilateral and bilateral nodules, supporting simultaneous VATS resection. [ABSTRACT FROM AUTHOR]

Indocyanine Green (ICG) is a clinically approved near‐infrared fluorescent dye that is used extensively for various imaging and diagnostic procedures. One drawback with ICG is its instability in water, which means that reconstituted clinical doses have to be used very shortly after preparation. Two deuterated versions of ICG were prepared with deuterium atoms on the heptamethine chain, and the spectral, physiochemical, and photostability properties were quantified. A notable mechanistic finding is that self‐aggregation of ICG in water strongly favors dye degradation by a photochemical oxidative dimerization reaction that gives a nonfluorescent product. Storage stability studies showed that replacement of C−H with C−D decreased the dimerization rate constant by a factor of 3.1, and it is likely that many medical and preclinical procedures will benefit from the longer shelf‐lives of these two deuterated ICG dyes. The discovery that ICG self‐aggregation promotes photoinduced electron transfer can be exploited as a new paradigm for next‐generation photodynamic therapies. [ABSTRACT FROM AUTHOR]

Purpose. To describe a case of subretinal hemorrhage due to the Valsalva maneuver in a patient with no underlying chorioretinal disease. Methods. History and clinical examination, optical coherence tomography (OCT), fluorescein, and indocyanine green angiography. Results. We report a case of a 35-year-old man with a 4-day history of central vision loss in the left eye (OS) after a vomiting episode. His best-corrected visual acuity was 20/200 in OS. Fundus examination revealed a subretinal hemorrhage in the posterior pole, associated with a small preretinal hemorrhage in the superotemporal arcade. OCT confirmed the presence of a thick submacular hemorrhage and a focal hemorrhage beneath the inner limiting membrane along the superotemporal arcade. The patient was submitted to pars plana vitrectomy (PPV), subretinal injection of tissue plasminogen activator (tPA), and air tamponade on the following day. Most of the submacular hemorrhage was displaced, resulting in a satisfactory visual outcome (BCVA = 20 / 30 after 1 month of surgery). Fluorescein and indocyanine green angiography excluded conditions such as retinal arterial macroaneurysm, polypoidal chorioretinopathy, and choroidal neovascularization. Conclusion. Although rare, Valsalva retinopathy may present with submacular hemorrhage in a patient with no underlying chorioretinal disease. PPV and subretinal tPA injection may provide a good visual outcome. [ABSTRACT FROM AUTHOR]

Aim: The albumin‐indocyanine green evaluation (ALICE) score is a useful predictor of post‐hepatectomy liver failure (PHLF); however, its usefulness in combination with future liver remnant (FLR), measured by 3‐D volumetry, has not been investigated. This study aimed to investigate the relationship between the ALICE of the FLR (ALICE‐FLR) score and severe PHLF. Methods: The clinical data of 215 patients who underwent anatomical hepatectomy for hepatocellular carcinoma without portal vein embolization at two institutes between January 2010 and December 2021 were analyzed retrospectively. PHLF occurrence and severity were determined according to the International Study Group of Liver Surgery's definition. Grades B and C PHLF were defined as severe PHLF. The ALICE‐FLR, ALICE scores, and indocyanine green clearance of FLR (ICGK‐FLR) were evaluated for severe PHLF prediction. Results: Severe PHLF was observed in 40 patients (18.6%). The areas under the curve (AUCs) for the ALICE‐FLR, ALICE scores, ICGK‐FLR, and FLR were 0.76, 0.64, 0.73, and 0.69, respectively. The AUC of the ALICE‐FLR score was significantly higher than that of the ALICE score. The ALICE‐FLR score was identified as an independent predictor of severe PHLF (the odds ratio for every 0.01 increment in the ALICE‐FLR score was 1.24; 95% confidence interval, 1.070–1.453; p = 0.004). Among patients with severe PHLF, the ALICE‐FLR score was significantly higher in the grade C than in the grade B PHLF group. Conclusion: The combination of liver function models, including indocyanine green, albumin, and FLR is considered compatible for predicting severe PHLF. [ABSTRACT FROM AUTHOR]

This study aimed to develop material for multimodal imaging by means of X‐ray and near‐infrared containing FDA‐ and EMA‐approved iohexol and indocyanine green (ICG). The mentioned contrast agents (CAs) are hydrophilic and amphiphilic, respectively, which creates difficulties in fabrication of functional polymeric composites for fiducial markers (FMs) with usage thereof. Therefore, this study exploited for the first time the possibility of enhancing the radiopacity and introduction of the NIR fluorescence of FMs by adsorption of the CAs on hydroxyapatite (HAp) nanoparticles. The particles were embedded in the poly(L‐lactide‐co‐caprolactone) (P[LAcoCL]) matrix resulting in the composite material for bimodal near‐infrared fluorescence‐ and X‐ray‐based imaging. The applied method of material preparation provided homogenous distribution of both CAs with high iohexol loading efficiency and improved fluorescence signal due to hindered ICG aggregation. The material possessed profound contrasting properties for both imaging modalities. Its stability was evaluated during in vitro experiments in phosphate‐buffered saline (PBS) and foetal bovine serum (FBS) solutions. The addition of HAp nanoparticles had significant effect on the fluorescence signal. The X‐ray radiopacity was stable within minimum 11 weeks, even though the addition of ICG contributed to a faster release of iohexol. The stiffness of the material was not affected by iohexol or ICG, but incorporation of HAp nanoparticles elevated the values of bending modulus by approximately 70%. Moreover, the performed cell study revealed that all tested materials were not cytotoxic. Thus, the developed material can be successfully used for fabrication of FMs. [ABSTRACT FROM AUTHOR]

The development of fluorophores with photoemission beyond 1000 nm provides the opportunity to develop novel fluorescence microscopes sensitive to those wavelengths. Imaging at wavelengths beyond the visible spectrum enables imaging depths of hundreds of microns in intact tissue, making this attractive for volumetric imaging applications. Here, a novel shortwave‐infrared line‐scan confocal microscope is presented that is capable of deep imaging of biological specimens, as demonstrated by visualization of labeled glomeruli in a fixed uncleared kidney at depths beyond 400 µm. Imaging of brain vasculature labeled with the near‐infrared organic dye indocyanine green, the shortwave‐infrared organic dye Chrom7, and rare earth‐doped nanoparticles is also shown, thus encompassing the entire spectrum detectable by a typical shortwave‐infrared sensitive InGaAs detector. [ABSTRACT FROM AUTHOR]

Background: Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone. Methods: A split‐mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real‐time polymerase chain reaction. Results: Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls. Conclusions: Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels. [ABSTRACT FROM AUTHOR]

Colloidal nanoparticles (NPs) containing near-infrared-fluorescent J-aggregates (JAGGs) of pyrrolopyrrole cyanines (PPcys) stabilized by amphiphilic block co-polymers were prepared in aqueous medium. JAGG formation can be tuned by means of the chemical structure of PPcys, the concentration of chromophores inside the polymeric NPs, and ultrasonication. The JAGG NPs exhibit a narrow emission band at 773 nm, a fluorescence quantum yield comparable to that of indocyanine green, and significantly enhanced photostability, which is ideal for long-term bioimaging. [ABSTRACT FROM AUTHOR]

The traditional indications for lobectomy for resectable Non‐small Cell Lung Cancer (NSCLC) may be set to change. Recently, anatomical segmentectomy (AS) versus lobectomy as an approach for early‐stage NSCLC has been described in phase 3 randomised controlled trials. The demand for methods to facilitate AS may increase as a consequence. We describe three cases of AS using the combination of endobronchial infiltration of indocyanine green (ICG) to identify the intersegmental plane (critical for the performance of AS), and Computed Tomography (CT) guided methylene blue injection for lesion localisation. The operations were completed successfully demonstrating satisfactory post‐operative outcomes including lesion resection with clear surgical margins and acceptable length of stay. We believe that endobronchial instillation of ICG and CT‐guided methylene blue injection for lesion localisation show promise as a technique to complement parenchymal sparing thoracic oncological surgery. [ABSTRACT FROM AUTHOR]

Increasing oxygen (O2) content and down‐regulating the concentration of glutathione (GSH) in tumor microenvironment (TME) by multiple approaches remain critical factors for the promotion of phototherapeutic effect, especially for photodynamic therapy (PDT). Herein, indocyanine green (ICG) laden dendritic mesoporous manganese‐silicon nanocomposite (NC) is designed and subsequently managed with calcification through in situ growth of calcium phosphate (IDMMS@CaP NC). As specific response behavior of the mildly acidic and GSH overexpressed TME, the IDMMS@CaP NC can rapidly collapse when accumulated at the tumor site, liberate Mn2+, Ca2+, and ICG, simultaneously reduce the concentration of GSH. Mn2+ can catalyze endogenous hydrogen peroxide to produce O2. Overloaded Ca2+ induces mitochondrial injury, and reduces cellular metabolism and O2 consumption. The photothermal effect from ICG with 808 nm laser irradiation can not only cause tumor cells necrosis but also accelerate blood flow to further improve the O2 content at the tumor site. Consequently, owing to effective GSH depletion and multiple O2 compensation, the PDT efficiency of ICG can be significantly increased. As proof of concept, the designed multifunctional nanocomposite will provide a general strategy for enhancing the role of phototherapy in cancer therapeutic area. [ABSTRACT FROM AUTHOR]

High‐energy orthopedic injuries cause severe damage to soft tissues and are prone to infection and healing complications, making them a challenge to manage. Further research is facilitated by a clinically relevant animal model with commensurate fracture severity and soft‐tissue damage, allowing evaluation of novel treatment options and techniques. Here we report a reproducible, robust, and clinically relevant animal model of high‐energy trauma with extensive soft‐tissue damage, based on compressed air‐driven membrane rupture as the blast wave source. As proof‐of‐principle showing the reproducibility of the injury, we evaluate changes in tissue and bone perfusion for a range of different tibia fracture severities, using dynamic contrast‐enhanced fluorescence imaging and microcomputed tomography. We demonstrate that fluorescence tracer temporal profiles for skin, femoral vein, fractured bone, and paw reflect the increasing impact of more powerful blasts causing a range of Gustilo grade I–III injuries. The maximum fluorescence intensity of distal tibial bone following 0.1 mg/kg intravenous indocyanine green injection decreased by 35% (p < 0.01), 75% (p < 0.001), and 87% (p < 0.001), following grade I, II, and III injuries, respectively, compared to uninjured bone. Other kinetic parameters of bone and soft tissue perfusion extracted from series of fluorescence images for each animal also showed an association with severity of trauma. In addition, the time‐intensity profile of fluorescence showed marked differences in wash‐in and wash‐out patterns for different injury severities and anatomical locations. This reliable and realistic high‐energy trauma model opens new research avenues to better understand infection and treatment strategies. Level of evidence: Level III; Case–control. [ABSTRACT FROM AUTHOR]

Aim: Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short‐term outcomes of minimally‐invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra‐corporal anastomosis [EA]). Methods: This was a retrospective analysis of the Minimally‐invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used. Results: The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile, <135 min (n = 386); (2) Second and third quartiles, 135–199 min (n = 731); and (3) Fourth quartile ≥200 min (n = 432). The majority (62.7%) were LRC‐EA, followed by LRC‐IA (24.3%), RRC‐IA (11.1%), and RRC‐EA (1.9%). Independent predictors of an OT ≥ 200 min included male gender, age, obesity, diabetes, use of indocyanine green fluorescence, and IA confection. An OT ≥ 200 min was significantly associated with an increased risk of postoperative noninfective complications (AOR: 1.56; 95% CI: 1.15–2.13; p = 0.004), whereas the surgical approach and the type of anastomosis had no impact on postoperative morbidity. Conclusion: Prolonged OT is independently associated with increased odds of postoperative noninfective complications in oncological minimally‐invasive right colectomy. [ABSTRACT FROM AUTHOR]

Fluorescence pharmacokinetic rates in tissues can provide additional specific and quantitative physiological and pathological information for evaluating organ function. This modality requires a highly sensitive diffuse fluorescence tomography (DFT) working in dynamic way to finally extract the pharmacokinetic rates from the measured pharmacokinetics‐associated temporally varying boundary intensity, normally with the support of a priori anatomy. This paper is devoted to study pharmacokinetics of indocyanine green (ICG) in mouse liver based on synergistic dynamic‐DFT and X‐ray computer tomography (XCT): A highly sensitive dynamic DFT system of CT‐scanning mode working with parallel 4 photomultiplier‐tube photon‐counting channels generates informative and instantaneous sampling datasets; An XCT system provides priori information of the target localization for improvement of the reconstruction quality; An analysis procedure extracts the pharmacokinetic rates from the reconstructed ICG concentration‐time curves, using the Gauss‐Newton scheme for fitting to a 2‐compartment model. The uptake and excretion rates of ICG which were obtained in livers of 10 healthy mice in the in vivo experiments can be used to quantitatively evaluate liver function. The results can validate the effectiveness of both the imaging measurements system and pharmacokinetic analysis method. Diffuse fluorescence tomography (DFT) is a powerful tool for noninvasively and quantitatively resolving the 3‐dimensional distribution of fluorescence in vivo. With the support of a priori anatomy from X‐ray computer tomography, a highly sensitive DFT working in dynamic way can extract the metabolism process and pharmacokinetic rates of fluorescence in tissue, which can be used to assess liver function, detect drug efficacy and monitor disease progression. [ABSTRACT FROM AUTHOR]

The sentinel node biopsy (SNB) is highly protocolized in other cancers, however, this is not the case for oral squamous cell carcinoma patients, hence our objective was to evaluate the different protocols published. A specific study protocol was designed and subsequently registered on PROSPERO (Ref. CRD42021279217). Twenty‐three articles were included in the meta‐analysis. The grouped sensitivity of the SNB was 82% (95% CI: 0.74–0.88), and the grouped specificity was 100% (95% CI: 0.99–1.00). The use of other radiotracers other than pre‐operative lopamidol showed higher values of sensitivity of 82.80% (95% CI: 76.90%–87.50%; p < 0.001). The use of the blue dye stain showed higher sensitivity values of 85.60% (95% CI: 71.90%–93.20%), compared to sensitivity values of 77.50% when it was not used (95% CI: 69.10%–84.20%) (p < 0.001). Diagnostic rates are variable and they were significantly better when 99mTc was used in all its variations and accompanied by the blue dye staining. [ABSTRACT FROM AUTHOR]

In head and neck oncologic surgery a reconstructive phase is often required and pedicled flaps are still a viable option, though they may need a pedicle division performed at a later stage. Several techniques are commonly used for perfusion assessment of the flaps, with indocyanine green (ICG) fluorescence video‐angiography representing a promising tool. We used ICG video‐angiography to evaluate the perfusion of two of the most commonly adopted pedicled flaps in the head and neck field (the supraclavicular and the paramedian forehead flap) before and after second‐stage pedicle division, allowing a safer in‐setting. Moreover, the new high‐resolution device that we have employed added further accuracy to the traditional video‐angiography, providing a real‐time flap‐to‐normal skin ICG ratio. Indeed, ICG video‐angiography proved to be a useful tool in head and neck reconstructive surgery and it may allow an earlier second‐stage pedicle division. [ABSTRACT FROM AUTHOR]

Objectives: To report surgical technique, perioperative, oncological, and mid‐term functional outcomes in a single‐center purely off‐clamp robotic partial nephrectomy series for totally endophytic masses. Methods: A retrospective analysis of a prospectively collected, institutional review board‐approved renal cancer database was carried out to include patients with a totally endophytic renal tumor treated with off‐clamp robotic partial nephrectomy between January 2013 and December 2020 at our center. Our database was queried to identify cases that had been assigned 3 points for the "E" domain of the R.E.N.A.L. nephrometry score and 3 points for the "exophytic rate" domain of the PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) nephrometry score. Preoperative indocyanine green renal mass marking was performed in 33 patients, in whom the tumor was vascularized by a specific feeding artery. Surgical steps, perioperative, oncological and functional data were reported. Results: Fifty‐six consecutive patients with totally endophytic renal masses were treated. The median tumor diameter was 3 cm, and median PADUA and R.E.N.A.L. scores were both 10. The median operative time was 82 min. Low‐grade Clavien complications occurred in two patients (3.6%) and high‐grade Clavien complications were observed in four patients (7.1%). Positive surgical margins were detected in one patient; 2‐year recurrence‐free, cancer‐specific, and overall survival rates were 100%, 100%, and 98.2%, respectively. At a median follow‐up of 24 months, new onset of chronic kidney disease stage 3b occurred in one patient. At last follow‐up, the median estimated glomerular filtration rate was 77 mL/min, with a median estimated glomerular filtration rate percent decrease of 5.5%. Trifecta was achieved in 91% of patients. Conclusions: Purely off‐clamp robotic partial nephrectomy is a feasible and safe surgical approach, even in totally endophytic renal tumors, providing a favorable perioperative complications rate, excellent oncological outcomes, and negligible impact on renal function at mid‐term follow‐up. Indocyanine green preoperative marking of endophytic renal tumors represents a useful tool for rapid intraoperative identification of the mass, real‐time control of resection margins, and a more precise dissection. [ABSTRACT FROM AUTHOR]

Background: To evaluate the diagnostic accuracies of indocyanine green (ICG) fluorescence for identifying parathyroid glands during surgery and predicting the postoperative function. Methods: From six databases, 21 studies were finally included in the study. True‐positive, true‐negative, false‐positive, and false‐negative data were extracted for the analysis. The quality of each study was analyzed using the QUADAS‐2 tool. Results: The sensitivity of ICG‐based parathyroid gland identification was 0.9380 (95% CI [0.9003, 0.9621]). The diagnostic odds ratio for ICG‐based prediction of parathyroid gland function was 54.5652 [13.2059, 225.4570]. The area under the summary receiver operating characteristic curve was 0.909. Fluorescence intensity‐based prediction presented higher diagnostic accuracy than that of score‐based prediction. The incidence of postoperative hypoparathyroidism was higher in the group with a zero ICG score compared to the high scored group. Conclusions: Identification of parathyroid gland and prediction of postoperative function using ICG are valuable to patients undergoing thyroidectomy or parathyroidectomy. [ABSTRACT FROM AUTHOR]

This in vitro study sought to assess the effect of repetitive PBMT on the viability of fibroblasts following aPDT with indocyanine green (ICG). In this in vitro experimental study, human gingival fibroblasts (HGFs) were obtained and incubated in a culture medium. After reaching 10 000 cells cm−2, the cells were divided into five groups of control, aPDT with ICG and 808 nm (energy density of 24 J cm−2), PBMT immediately after aPDT, PBMT with 660 nm (energy density of 7.2 J cm−2) immediately and 24 h after aPDT and PBMT immediately and 24 and 48 h after aPDT in 48‐well plates. Cell viability was evaluated using the methyl thiazolyl tetrazolium (MTT) assay after 1, 4 and 7 days of incubation. Statistical analyses were performed using one‐way ANOVA. Cell viability significantly decreased in group 2 (P < 0.002). We observed no significant increase in cell viability at any time point in group 3 (P > 0.05). Cell viability significantly increased in groups 4 and 5 after the first day of incubation (P < 0.000). Emission of 660 nm as PBMT for two and three times along with passage of time would increase the viability of HGFs following aPDT with ICG. [ABSTRACT FROM AUTHOR]

Background: During thyroid surgery, preservation of parathyroid gland (PG) feeding vessels is often impossible. The aim of the Fluogreen study was to determine the feasibility of using indocyanine green (ICG)-based intraoperative mapping angiograms of the PG (iMAP) to improve vascular preservation. Study design: This prospective study enrolled all patients undergoing thyroid lobectomy or total thyroidectomy at the Hôpital Européen Marseille between September and December 2018. After exploring the thyroid lobe by autofluorescence to locate the PGs, ICG solution was injected intravenously to locate the PG feeding vessels and guide dissection. A second ICG injection was administered at the end of the lobectomy to assess perfusion of the PGs. The primary outcome was the quality of the angiogram, scaled as iMAP 0 (not informative), iMAP 1 (general vascular pattern visible but no clear vascular pedicle flowing into the PG), or iMAP 2 (clear vascular pedicle flowing into the PG). The secondary outcome was the PG perfusion score at the end of surgery, scaled from ICG 0 (no perfusion) to ICG 2 (intense uptake). Results: A total of 47 adult patients were analyzed, including 34 total thyroidectomies and 13 lobectomies. ICG angiography assessed 76 PGs, which were scored as iMAP 2 in 24 cases (31.6%), iMAP 1 in 46 (60.5%) and iMAP 0 in six (7.9%). At the end of dissection, the ICG perfusion score was significantly better for the PGs with informative angiography (iMAP 1 or 2), than for the PGs with uninformative angiography (iMAP 0), or the PGs not evaluated by vascular angiography (p < 0.05). Conclusion: iMAP is feasible and provides direct vascular information in one-third of the cases. Further improvements to this technology are necessary, and the influence of this technique on patient outcomes during thyroidectomy will need to be further evaluated. [ABSTRACT FROM AUTHOR]

Aim: Redo ileocolic resection in patients with Crohn's disease (CD) is associated with significant technical challenges that may be associated with high complication rates. The aim of this study was to evaluate the feasibility of near‐infrared fluorescence angiography with indocyanine green (ICG), often used to evaluate blood supply to the anastomosis in CD patients undergoing repeat ileocolic resection. Method: This study was a retrospective analysis of patients who underwent redo ileocolic resection using ICG bowel perfusion assessment between 2015 and 2021. Patients were matched and compared on a 1:2 basis with a control group undergoing the same procedure without perfusion assessment. Results: Twelve patients underwent redo ileocolic resection with ICG perfusion assessment (ICG group). These were compared with 24 patients who underwent the procedure without ICG (control group). Both groups were similar in demographics and operative characteristics including median operating time (255 vs. 255.5 min, p = 0.39) and conversion rate (22% vs. 36.8%, p = 0.68). Median estimated blood loss was significantly higher in the ICG group [150 (50–400) vs. 100 ml (20–125)]. Successful ICG perfusion assessment was seen in all patients in the ICG group and did not change management in any case. Overall postoperative complication rates were comparable between the groups (58.3% vs. 54.1%, p = 0.72). No anastomotic leaks occurred in the ICG group compared with one (1/24, 4.2%) in the control group (p = 0.99). Conclusion: Fluorescence ICG perfusion assessment is feasible and safe in redo ileocolic resection in patients with CD. Larger studies are needed to evaluate whether this technique should be routinely used in these complex surgical interventions. [ABSTRACT FROM AUTHOR]

In the current study, a one‐pot method to prepare small lipid‐indocyanine green (ICG) nanoparticles (L‐ICG NPs) is proposed for the treatment of colorectal cancer. The L‐ICG NPs showed size distribution at around 20 nm with high stability and biocompatibility. In addition, they can respond to light irradiations to exert oxidative/thermal stress damage, which showed effective anticancer benefits in vitro and in vivo using HT‐29 cells as the model. [ABSTRACT FROM AUTHOR]

While still debated, it was advised to perform a protective temporary ileostomy after a low anterior resection (LAR). This might help to decrease the leak rate and therefore offers the patient better outcomes. Anastomotic leak can occur in many situations after a LAR and the control of the risk factors helps to adapt the need of an ileostomy. Near infrared technology allows assessing the microvascularisation of the anastomosis at the time of surgery and therefore might be an important tool to avoid a stoma in given situation. This article reviews the evidences with the use of this technology. [ABSTRACT FROM AUTHOR]

Colvin I et al i .7 studied 40 patients who underwent 43 adrenalectomies with the use of ICG. In a case series of 10 robotic adrenalectomies, Sound I et al i .4 reported that ICG imaging was helpful in the conduct of the operation in eight of 10 cases. Indocyanine green (ICG) is a water-soluble molecule that binds albumin and allows identification of vascular and anatomical structures.1 ICG has recently become available for minimally invasive surgery, providing additional information regarding tissue perfusion, vascular structures and planes of dissection.2 The adrenal gland is an optimal target for the use of ICG because of its high vascularity. [Extracted from the article]

Aim: This study aims to evaluate the extrinsic effects of conditional factors affecting quantitative parameters and to establish the optimization of indocyanine green (ICG) angiography using in vitro experiments and a prospective observational study. Method: In vitro experiments were performed to evaluate the correlation between conditional factors such as camera distance, surrounding lighting, fluorescence emission sources and ICG doses. The fluorescence intensity was measured from the ICG‐containing test tube in each condition. In the clinical study, ICG angiography was applied to patients with colorectal cancer (n = 164). The quantitative perfusion parameters were the maximal fluorescence intensity (FMAX), slope, T1/2MAX and perfusion time ratio (TR). Camera position, distance to colon, fluorescence emission source, surrounding lighting, site of angiography and ICG specific mode were considered as conditional factors and compared with the quantitative parameters to identify the optimal condition of ICG angiography. Results: The fluorescence intensity had an inverse correlation with distance, and the transitional zone was shown at a distance of 4–5 cm by slope differential. FMAX, T1/2MAX and slope were affected significantly by camera distance, site of angiography, fluorescence emission source and ICG mode as conditional factors. On multivariate analysis, FMAX was independently associated with spectral ICG mode with red inversion, laser mode and camera distance. Conversely, TR was not related to any conditional factors. Conclusion: Since quantitative parameters of ICG angiography are influenced by various conditions, a standardized protocol is required. The application of ICG specific modes with a constant distance of 4–5 cm can provide optimized fluorescence images. [ABSTRACT FROM AUTHOR]

Near‐infrared (NIR) fluorescence imaging has advanced medical imaging and image‐guided interventions during the past three decades. Despite tremendous advances in imaging devices, surprisingly only a few dyes are currently available in the clinic. Previous fluorophores, ZW800‐1A and ZW800‐1C, significantly improved the poor performance of the FDA‐approved indocyanine green. However, ZW800‐1A is not stable in serum and ZW800‐1C induces severe stacking in aqueous media. To solve such dilemmas, ZW800‐PEG was designed by introducing a flexible yet stable thiol PEG linker. ZW800‐PEG shows high solubility in both aqueous and organic solvents, thus improving renal clearance with minimal binding to serum proteins during systemic circulation. The sulfide group on the meso position of the heptamethine core improves serum stability and physicochemical properties including the maximum emission wavelength shift to 800 nm, enabling the use of ZW800‐PEG for image‐guided interventions and augmenting photothermal therapy. [ABSTRACT FROM AUTHOR]

Aim: Abdominoperineal resection is associated with poor prognosis in patients with advanced lower rectal cancer. This study aimed to analyse the functional lymphovascular network and tissue drainage in the anorectal region. Methods: In this descriptive study, we performed microanatomical evaluations and intra‐operative imaging analysis in a cadaver and patients with rectal cancer. Specimens with India ink injection were collected from a cadaver and from six patients who underwent abdominoperineal resection. Intra‐operative indocyanine green fluorescence imaging was performed on four patients who underwent surgery for lower rectal cancer. India ink was injected into the submucosa at the dentate line of specimens. Tissue sections were examined by immunohistochemistry for D2‐40 and CD31. Intra‐operative indocyanine green was injected into the submucosa at the dentate line. Lymph flow was traced using a near‐infrared camera system. Results: Fascia branching from the rectal longitudinal muscle layer extended to the posterior hiatal ligament and lateral endopelvic fascia connective tissue lamina on the surface of the levator ani muscle. The fascia contained veins labelled with ink in their lumina and initial lymphatics. Intra‐operative indocyanine green fluorescence imaging revealed extensive lymph flow from the muscle layer of the anal canal to the hiatal ligament and endopelvic fascia along the longitudinal muscle layer fibres. Conclusions: The anorectal region contained widespread venous and lymphatic networks in proportion to its specific connective tissue framework around the longitudinal‐muscle‐layer‐extending muscle bundles, which provides extensive networks for tissue fluid and cells. [ABSTRACT FROM AUTHOR]

Background: We re‐analyzed data on cholangio‐venous reflux from a clinical study conducted prospectively on 22 patients in 1974. Method: Direct cholangiography was performed with indocyanine green (ICG) mixed into UrographinR under monitoring of intrabiliary pressure, and the participants were allocated to three groups according to whether ICG leakage into the blood, signs of infection, or both, were present. Results: The intrabiliary pressure of six patients negative for both ICG leakage and signs of infection was approximately 19.5 (median, [range 18‐22]) cmH2O. In contrast, for the five patients positive for ICG leakage but negative for signs of infection, the intrabiliary pressure was higher (median 32.0 [range 27‐41) cmH2O]. The 11 patients positive for both ICG leakage and signs of infection had the highest intrabiliary pressure (median 48.0 [range 33‐77] cmH2O). Our analyses revealed that, as the intrabiliary pressure increased, the status of ICG leakage and signs of infection appeared in a stepwise fashion. Conclusion: Our findings suggest that the tight junctions sealing the bile canaliculi deteriorated with increasing intrabiliary pressure, resulting in reflux of the biliary contents into the vascular system via paracellular pathways between hepatocytes. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood‐tumor barrier (BTB) permeability in tumor periphery due to glioma‐induced vascular dysregulation allow T1 contrast‐enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5‐aminolevulinic acid (5‐ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)–based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood‐brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri‐ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy. [ABSTRACT FROM AUTHOR]

Aim: Up to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral injury. While preoperative ureteral stenting to facilitate identification of the ureter is common, it does not reduce the incidence of intraoperative ureteral injury and is not without risk. As we continue to broaden the application of minimally invasive surgical techniques, a new form of ureteral identification and avoidance that does not rely on tactile feedback is needed. We report our initial experience with intraureteral indocyanine green (ICG) for ureteral identification and avoidance during complex robotic‐assisted colorectal surgery. Method: Patients undergoing adjunctive ureteral identification during robotic‐assisted colorectal surgery were prospectively identified. Each patient underwent intraureteral ICG administration using rigid cystoscopy (22 Fr). A 5‐Fr open‐ended ureteral catheter was inserted up to 20 cm and used to inject 5 ml of 2.5 mg/ml ICG as the catheter was withdrawn to the ureteral orifice. Intraureteral ICG was then detected using near‐infrared laser fluorescence technology (Firefly®). Results: Successful ICG‐enhanced ureteral identification and avoidance was performed in 15 of 16 (94%) patients undergoing robotic‐assisted colorectal surgery. The median ICG instillation time was 11.5 min (range 4–21 min) and the median operative time with ICG visualization was 489 min (8 h 9 min) [range 268–738 min (4 h 28 min–12 h 18 min)]. No patient experienced intraoperative ureteral injury and there were no adverse sequelae or complications associated with intraureteral ICG administration. Conclusion: Intraureteral ICG is a safe and effective method of intraoperative ureteral identification and avoidance during complex robotic‐assisted colorectal surgery. Precise and prolonged ureteral visualization was achieved, allowing for long operative times compatible with complex robotic‐assisted operations. [ABSTRACT FROM AUTHOR]

Background: Photodynamic antimicrobial chemotherapy (PACT) is a promising modality for eradication of microorganisms from the wound. This study aimed to investigate the effectiveness of PACT using indocyanine green (ICG) for reduction of bacterial load of oral ulcers in rats and its impact on the healing process. Methods: In this experimental study, 50 adult male Sprague Dawley rats were recruited. Oral ulcers were surgically made on the left cheek mucosa, and animals were randomly assigned into five groups (n = 10). Wound site in groups 1, 2, and 3 was irrigated with the sterile saline (0.9%), chlorhexidine (CHX; 0.2%), and ICG solutions (1 mg/mL), respectively. Group 4 was exposed to laser irradiation using 810 nm diode laser on continuous‐wave mode for 30 seconds (fluence: 55 J/cm2, power: 300 mW, spot size: 4.5 mm). In group 5, PACT was performed using topical application of ICG followed by laser irradiation in the same way as the previous group. Bacterial load of oral ulcers was assessed before and after each treatment modality. Besides, rats were sacrificed on the 5th day post ulceration and histological features of healing were evaluated. Results: Bacterial load was significantly reduced merely in the PACT‐ICG‐treated group by one log (P <.0001). Animals in the PACT‐ICG‐treated group also showed an accelerated healing in comparison with others on the 5th day of an experiment. Conclusion: Photodynamic antimicrobial chemotherapy using topical application of ICG has a potential to reduce the bacterial load of oral ulcers and accelerate wound repair. Therefore, it can be considered as an alternative to currently available modalities for wound management. [ABSTRACT FROM AUTHOR]

Purpose: To compare the lesion sizes of macular neovascularization (MNV) imaged with spectral‐domain (SD) and swept‐source (SS) optical coherence tomography angiography (OCTA) as well as indocyanine green angiography (ICGA). Methods: In this prospective, observational case series, patients showing a secured diagnosis of MNV on ICGA or Fluorescein Angiography, were imaged by SD‐OCTA and SS‐OCTA on the same day. Lesion size was measured on 3 × 3‐mm2 and 6 × 6‐mm2 scans using the Maestro 2 SD‐OCTA (Topcon Corporation, Tokyo Japan) and the Triton SS‐OCTA device (Topcon Corporation, Tokyo Japan) and compared to ICGA (Spectralis HRA, Heidelberg, Germany). Results: Twenty eyes from 20 patients (11 females, 55%) were enrolled. The neovascularization area measured on 6 × 6‐mm2 SD‐OCTA was lower compared to that outlined on SS‐OCTA, however, not reaching statistical significance (p = 0.094). Regarding 3 × 3‐mm2 measurements, the median lesion sizes between the two OCTA devices were comparable (p = 0.492). Indocyanine green angiography depicted a larger lesion area than both OCTA devices, however, not reaching statistical significance. Conclusion: SD‐OCTA tends to show smaller areas of MNV extension than SS‐OCTA regarding 6 × 6 mm2 scans. The lesion size of MNV can be very well compared between the different devices, emphasizing the use of OCTA for monitoring neovascular area. Lesion measurements on SS‐OCTA correlate better with ICGA than SD‐OCTA. [ABSTRACT FROM AUTHOR]

Aim: Pelviperineal wound complications frequently occur after salvage surgery for chronic pelvic sepsis despite using an omentoplasty. Sufficient perfusion of the omentoplasty following mobilization is essential for proper healing. This study investigated the impact on short‐term clinical outcomes of fluorescence angiography (FA) using indocyanine green for assessment of omental perfusion in patients undergoing salvage surgery. Method: This was a comparative cohort study including consecutive patients who underwent combined abdominal and transanal minimally invasive salvage surgery with omentoplasty at a national referral centre for chronic pelvic sepsis between December 2014 and August 2019. The historical and interventional cohorts were defined based on the date of introduction of FA in April 2018. The primary outcome was pelviperineal non‐healing, defined by the presence of any degree of pelviperineal infection at the final postoperative evaluation. Results: Eighty‐eight patients underwent salvage surgery with omentoplasty for chronic pelvic sepsis, of whom 52 did not have FA and 36 did have FA. The underlying primary disease was Crohn's disease (n = 50) or rectal cancer (n = 38), with even distribution among the cohorts (P = 0.811). FA led to a change in management in 28/36 (78%) patients. After a median of 89 days, pelviperineal non‐healing was observed in 22/52 (42%) patients in the cohort without FA and in 8/36 (22%) patients in the cohort with FA (P = 0.051). Omental necrosis was found during reoperation in 3/52 and 0/36 patients, respectively (P = 0.266). Conclusion: After introduction of FA to assess perfusion of the omentoplasty, halving of the pelviperineal non‐healing rate was observed in patients undergoing salvage surgery for chronic pelvic sepsis. [ABSTRACT FROM AUTHOR]

Aim: Transanal total mesorectal excision is a promising novel sphincter‐saving procedure for low rectal cancer. However, the transanal bottom‐up dissection is associated with increased rates of iatrogenic urethral injuries. Near‐infrared fluorescence (NIRF) imaging, given its deeper tissue penetration, has been explored in a limited number of studies for enhanced intra‐operative urethral visualization. In this study, we explored the feasibility of a novel, ultrabright, biocompatible fluorescent polymer to coat urinary catheters for the purpose of intra‐operative urethral visualization. Methods: In an ex vivo experiment, using a near‐infrared laparoscope, the fluorescent signal of a coated catheter (near‐infrared coating of equipment, NICE) was qualitatively and quantitatively compared to the signal of indocyanine green (ICG)/Instillagel® mixtures and ICG‐filled catheters at several concentrations. Also, in three male human torsos, using fluorescent urinary catheters, NIRF‐guided perineal dissections and a transanal total mesorectal excision were performed. Intra‐operative NIRF‐based urethral visualization was performed systematically. Results: During the qualitative and quantitative fluorescence signal assessment, NICE‐coated catheters were clearly superior to the ICG‐based solutions. In the cadaveric experiments, enhanced urethral visualization was possible even at early stages of dissection, when the organ was covered by several tissue layers. Conclusions: NICE‐coated catheters represent a promising potential to allow for NIRF‐based intra‐operative urethral visualization. [ABSTRACT FROM AUTHOR]

Aim: Intra‐operative fluorescence angiography (IOFA) with indocyanine green provides information on tissue perfusion that may help prevent an anastomotic leak (AL). The aim of this study was to assess the impact of IOFA on outcomes after left‐sided colonic or low anterior resection with anastomosis for colorectal cancer. Methods: All patients with left‐sided colonic or rectal cancer, operated between June 2017 and December 2018, were prospectively included. IOFA has been routinely implemented since May 2018. Reproducibility of IOFA, after a 1:1 matching for relevant clinical risk factors of AL, was studied in patients with IOFA (IOFA+) and without IOFA (IOFA−). Outcomes were compared in terms of postoperative events such as clinically relevant AL as the primary end‐point. Results: In the IOFA+ group, changing of the initially planned colon transection due to inadequate perfusion occurred in five out of 46 patients (10.9%). Agreement between intra‐operative assessment and postoperative blind review of IOFA was deemed strong (Cohen's kappa index 0.893, 95% CI 0.788–0.998, P < 0.001). Among 111 patients, 42 matched patients were included in each group. There was significantly more clinically relevant AL in the IOFA− group compared to the IOFA+ group (16.7% vs 2.4%, P = 0.026) involving significantly more anastomotic dehiscence which required re‐intervention (19% vs 2.4%, P = 0.014). Additionally, more descending colon ischaemia/necrosis was observed in the IOFA− group compared with the IOFA+ group (9.5% vs 0%, P = 0.040). Conclusion: In this prospective case‐matched study, IOFA decreased the occurrence of clinically relevant AL due to necrosis of the descending colon or anastomosis. Upon blind review, perfusion assessment using IOFA was reproducible. [ABSTRACT FROM AUTHOR]

Cracked teeth are the third most common cause of tooth loss, but there is no reliable imaging tool for the diagnosis of cracks. Here, we demonstrate the feasibility of indocyanine green near‐infrared fluorescence (ICG‐NIRF) dental imaging for the detection of enamel cracks and enamel–dentin cracks in vitro in the first (ICG‐NIRF‐I, 700–950 nm) and second (ICG‐NIRF‐II, 950–1700 nm) imaging windows with transmission excitation light, and compared ICG‐NIRF with conventional NIR illumination‐II (NIRi‐II) and X‐ray imaging. Dentin cracks were detected by CT scan, while most enamel cracks, undetectable under X‐ray imaging, were clearly visible in NIR images. We found that ICG‐NIRF‐II detected cracks more effectively than NIRi‐II, and that light orientation is an important factor for crack detection: an angled exposure obtained better image contrast of cracks than parallel exposure, as it created a shadow under the crack. Crack depth could be evaluated from the crack shadow in ICG‐NIRF and NIRi‐II images; from this shadow we could determine crack depth and discriminate enamel–dentin cracks from craze lines. Cracks could be observed clearly from ICG‐NIRF images with 1‐min ICG tooth immersion, although longer ICG immersion produced images with greater contrast. Overall, our data show that ICG‐NIRF dental imaging is a useful tool for diagnosing cracked teeth at an early stage. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to evaluate the efficacy of indocyanine green (ICG) fluorescence angiography (FA) in reducing the incidence of anastomotic leakage (AL) following colorectal anastomosis. Method: A single‐centre randomized trial was undertaken between 2018 and 2019. Those patients who underwent a stapled colorectal anastomosis were randomized 1:1 for ICG FA versus visual clinical assessment of blood perfusion of the anastomosed colon and rectal stump (non‐ICG FA group). The primary end‐point was to assess whether ICG FA was associated with a reduction in the incidence of AL. Secondary outcomes were the rate of postoperative complications and change in the level of bowel resection. Results: A total of 380 patients undergoing sigmoid and rectal resection were enrolled. After randomization, three patients were excluded. The results of 377 cases were available for analysis; 187 had ICG FA and 190 were in the non‐ICG FA group. ICG FA identified impaired blood perfusion of the colon in 36 (19%) cases. An AL (grade A, B or C) developed in 48 patients: 17 (9.1%) in the ICG FA group and 31 (16.3%) in the non‐ICG FA group (P = 0.04). ICG FA did not decrease the rate of AL of high anastomoses (9–15 cm from the anal verge), at 1.3% vs 4.6% in the non‐ICG FA group (P = 0.37). In contrast, a decrease in AL rate was found for low (4–8 cm) colorectal anastomoses (14.4% in ICG FA vs 25.7% in the non‐ICG FA group; P = 0.04). Conclusion: ICG FA is associated with a reduction in AL following low anterior resection. [ABSTRACT FROM AUTHOR]

Purpose: Near‐infrared fluorescence (NIRF) imaging using exogenous contrast has gained much attention as a technique for enhancing visualization of vasculature using untargeted agents, as well as for the detection and localization of cancer with targeted agents. In order to address the emerging need for standardization of NIRF imaging technologies, it is necessary to identify the best practices suitable for objective, quantitative testing of key image quality characteristics. Toward the development of a battery of test methods that are rigorous yet applicable to a wide variety of devices, we have evaluated techniques for phantom design, measurement, and calculation of specific performance metrics. Methods: Using a NIRF imaging system for indocyanine green imaging, providing excitation at 780 nm and detection above 830 nm, we explored methods to evaluate uniformity, field of view, spectral crosstalk, spatial resolution, depth of field, sensitivity, linearity, and penetration depth. These measurements were performed using fluorophore‐doped multiwell plate and high turbidity planar phantoms, as well as a 3D‐printed multichannel phantom and a USAF 1951 resolution target. Results and Conclusions: Based on a wide range of approaches described in medical and fluorescence imaging literature, we have developed and demonstrated a cohesive battery of test methods for evaluation of fluorescence image quality in wide‐field imagers. We also propose a number of key metrics that can facilitate direct, quantitative comparison of device performance. These methods have the potential to facilitate more uniform evaluation and inter‐comparison of clinical and preclinical imaging systems than is typically achieved, with the long‐term goal of establishing international standards for fluorescence image quality assessment. [ABSTRACT FROM AUTHOR]

By administering ICG test immediately before laparoscopic liver cyst fenestration, the biliary tract can be easily identified and intraoperative bile duct damage and postoperative bile fistula formation can be avoided, as demonstrated in this case. [ABSTRACT FROM AUTHOR]

Background: We investigated the safety and feasibility of intraoperative near‐infrared (NIR) imaging using indocyanine green (ICG) during sympathectomy in the management of primary palmar hyperhidrosis (PPH). Methods: We performed a retrospective review of 142 patients (ICG group) who underwent endoscopic thoracic sympathectomy (ETS) between February 2018 and April 2019. All patients received a 5 mg/kg infusion of ICG 24 hours preoperatively. The vital signs before and after ICG injection and adverse reactions were recorded. Meanwhile, 498 patients (Non‐ICG group) who underwent ETS by normal thoracoscopy during August 2017 to April 2019 were also reviewed to compare the abnormal white blood cell (WBC) counts, alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), and creatinine (Cr) levels before and after operation between two groups. Results: For ICG group, the vital signs including body temperature, heart rate and blood pressure before and after ICG injection were stable. There was no significant difference in the abnormal WBC counts, ALT, AST, BUN, and Cr levels before and after operation between two groups. Only one patient had mild adverse reaction (0.7%) after ICG injection. The visibility rate of all sympathetic ganglions was 96.7% (1369/1415). The visibility rate from T1 to T5 was 98.23% (278/283), 98.23% (278/283), 97.17% (275/283), 95.76% (271/283), and 94.35% (267/283), respectively. There was no significant difference in the visibility rate with regard to age, gender, height, weight, body mass index, and PPH grade. Conclusions: NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible. Key points: • Significant findings of the study. NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible. • What this study adds. This technology may take the place of the rib‐oriented method as standard practice for the precise localization of sympathetic ganglions, and may improve the effect of sympathectomies. [ABSTRACT FROM AUTHOR]

A 28-year-old man presented to the emergency room with blurred vision in the right eye for two days. He reported a preceding flu-like illness one week earlier. His best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/25 in the left eye. There was no anterior chamber inflammation or vitritis in either eye. He presented multiple yellowish-white placoid lesions in the posterior pole, some involving the foveal area, bilaterally. General examination and systemic investigation were unremarkable. Multimodal evaluation with fluorescein angiography, indocyanine green angiography, and spectral domain and optical coherence tomography angiography (OCTA) were consistent with the diagnosis of acute posterior multifocal placoid pigment epitheliopathy. Due to centromacular involvement with decreased BCVA, treatment with oral methylprednisolone was started after infectious causes were ruled out. After two weeks, the patient presented functional and anatomical improvement. OCTA showed partial reperfusion of the choriocapillaris in the affected areas, in both eyes. [ABSTRACT FROM AUTHOR]

A large number of chemotherapeutic drugs, utilized in the treatment of advanced metastatic clear cell renal cell carcinoma, are typically prone to poor biocompatibility, lack of targeting specificity, and high toxicity, which mostly leads to unsatisfactory clinical outcomes. As a new drug delivery pathway, nanoliposomes have the advantages of simplifying metabolism, reducing drug side‐effects, and providing specific targeting, which can potentially improve the therapeutic effect toward tumor therapy. In this study, a clinically integrated nanoliposome containing Sertraline Hydrochloride and indocyanine green (ICG), here named as Ser/ICG@Lip, was successfully synthesized by film‐dispersion and hydration–sonication methods. The photoacoustic imaging and near‐infrared fluorescence imaging capabilities of this novel nanoliposome were validated in vitro. The high encapsulation rate of Sertraline Hydrochloride and ICG ensured the safety and therapeutic efficacy of the particle. Moreover, our results suggest that chemo‐photothermal combination therapy can be more effective than single photothermal or chemotherapy treatments against malignant tumor cells. This is the first study introducing Sertraline Hydrochloride as a liposome‐encapsulated chemotherapeutic agent, containing photothermal capabilities, for the treatment of metastatic renal clear cell cancer cells. This novel drug system has potential to evolve into an alternate treatment method for metastatic clear cell renal cell carcinoma. [ABSTRACT FROM AUTHOR]

Indocyanine green (ICG) provides an advantage in the imaging of deep tumors as it can reach deeper location without being absorbed in the upper layers of biological tissues in the wavelengths, which named "therapeutic window" in the tissue engineering. Unfortunately, rapid elimination and short‐term stability in aqueous media limited its use as a fluorescence probe for the early detection of cancerous tissue. In this study, stabilization of ICG was performed by encapsulating ICG molecules into the biodegradable polymer composited with poly(l‐lactic acid) and poly(ε‐caprolactone) via a simple one‐step multiaxial electrospinning method. Different types of coaxial and triaxial structure groups were performed and compared with single polymer only groups. Confocal microscopy was used to image the encapsulated ICG (1 mg/mL) within electrospun nanofibers and in vitro ICG uptake by MIA PaCa‐2 pancreatic cancer cells. Stability of encapsulated ICG is demonstrated by the in vitro sustainable release profile in PBS (pH = 4 and 7) up to 21 days. These results suggest the potential of the ability of internalization and accommodation of ICG into the pancreatic cell cytoplasm from in vitro implanted ICG‐encapsulated multiaxial nanofiber mats. ICG‐encapsulated multilayer nanofibers may be promising for the local sustained delivery system to eliminate loss of dosage caused by direct injection of ICG‐loaded nanoparticles in systemic administration. [ABSTRACT FROM AUTHOR]