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Minimally invasive surgical creation of a peritoneal window for the treatment of lymphoceles post-kidney transplant is an effective procedure that comes with an elevated risk of iatrogenic injury to the urinary tract. Here, we present indocyanine green dye injection through a ureteral stent for intraoperative identification and avoidance of the transplant collecting system during peritoneal window creation. The procedure was successful and allowed for the resolution of the lymphocele without complication.

Background: Inadequate bowel perfusion is among risk factors for colorectal anastomotic leaks. Perfusion can be assessed with indocyanine green fluorescence angiography (ICG) during colon resections. Possible benefits from its systematic use in high-risk patients with rectal cancer remain inconsistent. This study aimed to evaluate the surgical modifications induced by ICG assessment during rectal cancer surgery and associated anastomotic leaks. Methods: This prospective before and after cohort study was conducted in a single Canadian high-volume colorectal surgery center. Eligible patients were undergoing a low anterior resection for rectal cancer below 15 cm from the anal margin. Stapled and handsewn coloanal anastomoses were included. The experimental group was recruited prospectively, undergoing surgery using fluorescence angiography with ICG. The control group was built retrospectively from consecutive patients who had been operated on without ICG, prior to its implementation. Results: Each cohort included 113 patients. The use of ICG led to modifications from initial surgical plan in 10.6% of patients, with no occurrence of anastomotic leaks in this specific group. When comparing leak rates, using ICG seemed to be protective, but this could not be statistically proven, overall (13.3% vs. 6.2%, p = 0.07), nor for handsewn coloanal anastomoses (11.8% vs. 5.9%, p = 0.67). A lack of power could explain such non-significant results, especially with low overall anastomotic leak rates recorded. Conclusion: ICG influenced ultimate proximal resection margin in a clinically relevant proportion of cases. It might be associated with reduced leak rates although not formally proven with this data. This technology is safe and easy to apply in high-volume colorectal centers. [ABSTRACT FROM AUTHOR]

The article discusses the feasibility of using Indocyanine Green (ICG) fluorescence endoscopic assisted resection for sinonasal tumors. The study aimed to evaluate the completeness of tumor resection using ICG fluorescence endoscopy, which proved to be feasible and helpful in visualizing and resecting sinonasal tumors. The study included five patients with different types of malignancies, and ICG fluorescence endoscopy assisted in identifying neoplastic tissue with a positive predictive value of 71.4%. The article highlights the importance of achieving complete tumor resection for better patient prognosis and discusses the challenges and benefits of using ICG fluorescence endoscopy in this context. [Extracted from the article]

Introduction: Despite spectacular visuals and the seemingly convincing rationale of using indocyanine-green-enhanced fluorescence in assessing bowel perfusion during colorectal resections, a lingering sense of subjectivity remains in the challenge of quantifying this fluorescence. This prospective study analyzed the application of O2C® spectrophotometry to quantify zones of fluorescence on the large bowel during low anterior resection. Materials and methods: Patients receiving a low anterior resection for cancer of the mid- and lower rectum were enrolled in this observational prospective study between February 2020 and December 2022. O2C® blood-flow measurement was performed at three different zones of fluorescence intensity (optimal [O], sufficient [S], and absent [A]), visualized at the designated and already skeletonized site of colon transection. The primary end point was to assess whether the O2C® flow value exceeds 164 arbitrary units (AU) at the zone of optimal fluorescence. The secondary objective was to assess whether there were statistically significant differences in flow parameters between the three zones, thus confirming reproducibility of measurements. Results: A total of 40 patients were enrolled in this study. Of these, 38 patients remained for statistical analysis with regard to O2C® measurement of the fluorescence zones. The O2C® flow parameter measured at the zone of optimal fluorescence was greater than 164 AU in all cases (100%, p < 0.0001). There were statistically significant differences in flow parameters measured at the three different zones of fluorescence (O-S: p < 0.0001; O-A: p < 0.0001; S-A: p = 0.0023). Conclusion: This study proves the feasibility and reproducibility of quantifying zones of indocyanine green (ICG)-enhanced fluorescence on the bowel. All O2C® flow measurements that were collected at the zone of optimal fluorescence exceeded 164 AU, thereby adding more evidence to this value as a suggested cut-off parameter in terms of bowel perfusion. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion The aim of the present study was to determine the efficacy and safety of our newly developed ICG‐assisted nerve‐sparing (NS) robot‐assisted radical prostatectomy (RARP) through subjective and objective data.This study included 43 NS RARP patients, divided into ICG (23 patients) and non‐ICG (20 patients) groups. Immunohistochemical staining with nNOS antibodies was conducted on specimens of resected prostate from the base, middle, and apex to count nNOS‐positive cells. Fewer nNOS‐positive cells suggested higher quality for the NS procedure. Postoperative erectile function, urinary incontinence, lower urinary tract symptoms (LUTS) as evaluated by the International Prostate Symptom Score (IPSS), and lower urinary tract function were compared between groups, operative time, and adverse events.Only the number of n‐NOS‐positive cells at the base differed significantly between the ICG group (15.0 ± 6.9) and the non‐ICG group (26.9 ± 21.4, p = 0.02). Regarding LUTS, in the ICG group, significant improvement was only seen in postoperative IPSS scores (13.6 ± 4.9 to 8.7 ± 5.0, p = 0.02). No significant differences in the postoperative erectile function, urinary incontinence, and lower urinary tract function were seen between groups. In addition, significant differences in operative time and rate of adverse events were not observed between groups.Our innovative approach enhances the visualization of prostatic boundaries, suggesting potential for reliable and straightforward NS procedures, with a significant improvement in LUTS, without evidence of prolonged operative time or an increased frequency of adverse events. [ABSTRACT FROM AUTHOR]

Background: Lymphedema in the lower abdomen and genitals is unnoticeable and has no established diagnostic methods. In this study, we evaluated it using four examinations. Methods: We evaluated 25 patients with lymphedema in the legs, dividing the abdomen and genitals in four areas (right and left, upper and lower). The mean age was 58.6 years. In lymphoscintigraphy and indocyanine green (ICG) lymphography, we diagnosed lymphedema when dermal backflow was observed. ICG lymphography was performed in 13 patients. In ultrasonography, we determined the presence of edema when cobblestone pattern was observed. Subcutaneous fat thickness was also measured. The patients' subjective symptoms were identified on an interview. We compared the results among the examinations. Results: The positivity rates for lymphedema based on lymphoscintigraphy, ICG lymphography, ultrasonography, and subjective symptoms were 45.0%, 42.3%, 8.0%, and 34.0%, respectively. Two of the 13 patients who underwent all examinations complained of subjective symptoms of edema in areas that showed no abnormalities in the examinations. In contrast, 14 of the 25 patients had areas where they had no subjective symptoms despite having abnormalities in at least one of the tests. Those with subjective symptoms of edema tended to have thinner abdominal fat in both the upper and lower abdomen, but no significant difference was observed. Conclusion: Large differences were observed in the positive rate of edema in subjective symptoms and examinations of lymphedema in the lower abdomen and genitals. It is not important to determine which examination is best but rather to combine multiple examinations. [ABSTRACT FROM AUTHOR]

Background: Indocyanine green imaging (ICG) is an expansion technology that can contribute to the development of demanding techniques such as cortical-sparing adrenalectomy (CSA). The aim of this study was to determine in which cases CSA should be performed and when total adrenalectomy should be performed instead based on ICG fluorescence. Here, we present our experience through a series of cases and videos. Methods: Prospective and descriptive study on patients with surgical adrenal lesions who were proposed for CSA using ICG with near-infrared fluorescence imaging in our center. A first bolus of 6,25 mg ICG was administered intravenously upon exposure of the retroperitoneal plane. Fluorescence was visualized using a Storz® NIR/ICG endoscopic system. Results: Seven patients were proposed for CSA. After the application of ICG, a change in attitude was carried out in 71.4% of the cases (five of seven). In the two patients in whom CSA could be performed, the adrenal remnants were functional, and the resection margins of the surgical specimens were free of disease. The reasons why partial adrenalectomy could not be completed, and a total adrenalectomy was decided instead were the presence of a tumor located very close to the adrenal vein that prevented a correct remnant volume (n = 4) and one case of isofluorescent tumor with the adrenal parenchyma. Conclusion: ICG fluorescence guidance could help in the decision making to select patients intraoperatively for successful cortical preservation. [ABSTRACT FROM AUTHOR]

Impedance cardiography (ICG) plays a crucial role in clinically evaluating cardiac systolic and diastolic functions, along with various other cardiac parameters. However, its accuracy heavily depends on precisely identifying feature points reflecting cardiac function. Moreover, traditional signal processing techniques used to mitigate random noise and breathing artifacts may inadvertently distort the amplitude and temporal characteristics of ICG signals. To address this issue, this study investigates a noise and artifact elimination method based on Improved Complete Ensemble Empirical Mode Decomposition with Adaptive Noise (ICEEMDAN) and Particle Swarm Optimization-based Variational Mode Decomposition Algorithm (PSO-VMD). The goal is to preserve the amplitude and temporal features of ICG signals to ensure accurate feature point extraction and computation of associated cardiac parameters. Comparative analysis with signal processing methods employing various wavelet families and Ensemble Empirical Mode Decomposition (EEMD) in ICG signal processing applications reveals that the proposed method achieves superior signal-to-noise ratio (SNR) and lower root-mean-square error (RMSE), while demonstrating enhanced correlation and waveform consistency with the original signal. [ABSTRACT FROM AUTHOR]

Indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative method to accurately assess real-time tissue vascularity, perfusion and anastomotic patency in flap surgery. We illustrate a complex case of elbow reconstruction in an elderly patient with a free anterolateral thigh flap, which relied on intraoperative ICG to evaluate the flap pedicle and map the site of arterial occlusion. Supermicrosurgical instrumentation was employed to perform complex perforator-to-perforator anastomosis following resection of the vascular site of the lesion. These unique applications in a patient of known surgical risk enabled immediate flap salvage, and after 6 months postoperatively, the flap remained healthy with adequate wound healing.

Abstract Cellular senescence is considered an important tumour suppression mechanism in response to damage and oncogenic stress in early lesions. However, when senescent cells are not immune-cleared and persist in the tumour microenvironment, they can drive a variety of tumour-promoting activities, including cancer initiation, progression, and metastasis. Additionally, there is compelling evidence demonstrating a direct connection between chemo(radio)therapy-induced senescence and the development of drug resistance and cancer recurrence. Therefore, detection of senescent cells in tissues holds great promise for predicting cancer occurrence earlier, assessing tumour progression, aiding patient stratification and prognosis, and informing about the efficacy of potential senotherapies. However, effective detection of senescent cells is limited by lack of biomarkers and readout strategies suitable for in vivo clinical imaging. To this end, a nanoprobe composed of biocompatible polydopamine (PDA) nanoparticle doped with FDA-approved indocyanine green (ICG) dye, namely PDA-ICG, was designed as a contrast agent for senescence detection using photoacoustic imaging (PAI). In an in vitro model of chemotherapy-induced senescence, PDA-ICG nanoprobe showed an elevated uptake in senescent cells relative to cancer cells. In addition to its improved photostability, 2.5-fold enhancement in photoacoustic signal relative to ICG was observed. Collectively, the results indicate that the PDA-ICG nanoprobe has the potential to be used as a contrast agent for senescence detection of chemotherapy-induced senescence using PAI.

Bile duct injuries occur in 0.4 % of elective and 0.8 % of emergency laparoscopic cholecystectomies. The risk factors for bile duct damage and the optimal timing of laparoscopic cholecystectomy were studied. The emphasis is on theoretical and practical training of the surgeon as the main component of the prevention of bile duct injuries. The variant anatomy of vessels, bile ducts and important anatomical landmarks during the operation are described. During «complex cholecystectomy», «rescue strategies» are proposed and modern imaging techniques are reviewed. The concept of safe cholecystectomy is evaluated. The issues of damage classification are touched upon. Analysis of the literature showed that debate continues in the global surgical community about the correct tactics for managing these patients. There is also a problem in assessing complications and there is a lack of standardization of outcomes after laparoscopic cholecystectomy.

BACKGROUND: Bariatric surgery represents an actively developing surgery field. With this, thanks to using modern automated methods of dissecting and suturing the tissues, a significant decrease is observed in the number of postoperative complications. At the same time, the problem of surgical suture incompetence remains topical even at the present times. The traditional methods of intraoperative diagnostics of incompetence are the provocative tests: the methylene blue test and the air leak test. One of the promising methods for intraoperative control during surgery is the use of fluorescent visualization in the near infrared range using the indocyanine green (ICG). AIM: Evaluate the informativity of intraoperative diagnostics of machine suture incompetence during the longitudinal gastric resection using fluorescent visualization with indocyanine green (ICG) by using the pig model to imitate various reasons of incompetence and to control surgical complications using morphological tests. METHODS: The research was carried out with using 20 pigs, each of which underwent the longitudinal gastric resection. The animals were distributed into the following experimental groups: the control group with performing standard longitudinal gastric resection (n=4) and the tests groups with longitudinal gastric resection and modeling of two variants of mechanical reasons of incompetence (n=12), as well as the local ischemia group (n=4). Intraoperationally, the gastric lumen was filled with a solution containing methylene blue and indocyanine green, after which, an evaluation was performed of the developed staining or Indocyanine green fluorescence visualization. Besides, in the ischemia group, ICG was administered intravenously. On Day 7 after surgery, samples were taken for histological examination. RESULTS: In 10 out of 11 experiments with the mechanical factor of modeling used to stimulate the machine suture incompetence, ICG visualization was found, with the ingress of methylene blue found in two cases out of 11, respectively. In 90% of the cases, the transudation of ICG corresponded to significant signs of inflammation, with the ingress of methylene blue being found only in 20% of the cases. CONCLUSION: The method of intraluminal administration of Indocyanine green in “mechanical” models of machine suture incompetence upon longitudinal gastric resection is more informative comparing to the introduction of methylene blue. Data from fluorescent ICG-angiography completely correspond to the location of ischemia modeling area.

It is observed that the locations of the most functional lymphatic vessels in the lymphedematous limbs can differ significantly from those in healthy limbs. The aim of this study was to elucidate the lymphatic map of lymphedematous limbs. We retrospectively analyzed 59 patients (118 limbs) with lower limb lymphedema. Fifty-five were women and four were men. The mean age and duration of lymphedema was 62.4 and 7.7 years, respectively. For the lateral thigh lymphosome, we injected indocyanine green (ICG) at the lateral knee and measured the distance (Dt) between the anterior superior iliac spine (ASIS) and the point where the lymphatic vessels crossed the reference line (the line connecting the ASIS and the patellar center). For the lateral calf lymphosome, we injected ICG at the lateral ankle and measured the distance (Dc) between the inferior patellar border and the point where the lymphatic vessels crossed the reference line (the anterior border of the tibia). In the lateral thigh, the mean Dt was 30.4 ± 0.6 cm (range, 0–41 cm) and the distribution peaked at approximately 30 cm from the ASIS. In the calf, the mean Dc was 13.1 ± 0.9 cm (range, −11 to 32 cm). The distribution of lymphatic vessel locations was highly variable. We could establish the lymphatic map in the lymphedematous legs. The distribution of lymphatic vessels in the thigh and lower legs had one and two peaks, respectively.

This study aims to analyze the effect of profit quality and Islamic corporate social responsibility (ICSR) on firm value moderated by Islamic corporate governance (ICG). This study uses a quantitative approach. The population used is all Islamic Commercial Banks (ICB) registered with the Financial Services Authority (FSA) in 2018-2023. The sampling technique used purposive sampling and obtained 11 ICB samples. The data source used is secondary data in the form of documentation of each BUS's financial statements. This study uses multiple linear regression analysis techniques. The results of this study indicate that profit quality negatively affects firm value. ICSR positively affects firm value. ICG is unable to moderate the relationship between profit quality and firm value. ICG is unable to moderate the relationship between ICSR and firm value. This study can complement existing theories and be a reference for future research. This study can also be a reference for ICB in increasing ICB value, especially regarding profit quality and ICSR.

Introduction: Intraoperative indocyanine green fluorescence angiography (ICGFA) perfusion assessment has been demonstrated to reduce complications in reconstructive surgery. This study sought to advance ICGFA flap perfusion assessment via quantification methodologies. Method: Patients undergoing pedicled and free flap reconstruction were subjected to intraoperative ICGFA flap perfusion assessment using either an open or endoscopic system. Patient demographics, clinical impact of ICGFA and outcomes were documented. From the ICGFA recordings, fluorescence signal quality, as well as inflow/outflow milestones for the flap and surrounding (control) tissue were computationally quantified post hoc and compared on a region of interest (ROI) level. Further software development intended full flap quantification, metric computation and heatmap generation. Results: Fifteen patients underwent ICGFA assessment at reconstruction (8 head and neck, 6 breast and 1 perineum) including 10 free and 5 pedicled flaps. Visual ICGFA interpretation altered on-table management in 33.3% of cases, with flap edges trimmed in 4 and a re-anastomosis in 1 patient. One patient suffered post-operative flap dehiscence. Laparoscopic camera use proved feasible but recorded a lower quality signal than the open system.Using established and novel metrics, objective ICGFA signal ROI quantification permitted perfusion comparisons between the flap and surrounding tissue. Full flap assessment feasibility was demonstrated by computing all pixels and subsequent outputs summarisation as heatmaps. Conclusion: This trial demonstrated the feasibility and potential for ICGFA with operator based and quantitative flap perfusion assessment across several reconstructive applications. Further development and implementation of these computational methods requires technique and device standardisation.

Abstract Background Pancreaticoduodenectomy is associated with an incidence of postoperative complications of approximately 41%. One of the most severe complications is a postoperative pancreatic fistula. The exact cause of postoperative fistula development is still unknown, but it appears to be multifactorial. Proper perfusion of pancreatic remnant is essential for the healing of pancreaticojejunostomy. To date, there is no method to reliably evaluate the vascular supply of the remnant. One of the methods for the assessment of organ perfusion is the indocyanine green fluorescence. This study aims to determine if indocyanine green fluorescence is a reliable method to measure the perfusion of the post-resection pancreatic remnant. The secondary outcome is to determine if intraoperative evaluation of the vascular supply of the post-resection remnant may predict the increased risk of postoperative pancreatic fistula development. Methods This study is designed as a prospective, observational study. All consecutive patients undergoing open or robotic pancreaticoduodenectomies at our department during the 1st May 2024-31st December 2026 period will be enrolled. The exclusion criteria are an allergy to indocyanine green and refusal by the patient. The adequacy of the vascular supply of the post-resection pancreatic remnant will be intraoperatively evaluated using a fluorescence detector. Patients will be divided into two groups: Those with high risk of pancreatic fistula development and those with low risk. The incidence of pancreatic fistulas in both groups is to be compared. Postoperative data including morbidity, mortality, hospital stay, intensive care unit stay and postoperative fistula development will be collected. Discussion If an intraoperative assessment of the perfusion of post-resection pancreatic remnant using indocyanine green is proven to be a suitable method to estimate the increased risk of the pancreatic fistula, the list of the existing known risk factors could be expanded. In the most high-risk patients the modification of the surgical procedure could be considered. Trial registration Number: NCT06198400 ClinicalTrials.Gov. Date 08.01.2024.

Background: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag (1993) and Giuliano (1994), the method underwent numerous improvements and was also largely used worldwide. Methods: This article is a prospective study that took place at the "SJUPBT Surgery Clinic Timisoara" over a period of 1 year between July 2023 and July 2024, during which 137 underwent sentinel lymph node biopsy (SLNB) based on the current guidelines. For the identification of sentinel lymph nodes, we used various methods, including single traces and also a dual tracer and triple tracer. Results: Breast density represents a predictive biomarker for the identification rate of a sentinel node, being directly correlated with BMI (above 30 kg/m2) and with an age of above 50 years. The classification of the patients according to breast density represents an important criterion given that an adipose breast density (Tabar-Gram I-II) represents a lower IR of SLN compared with a density of the fibro-nodular type (Tabar-Gram III-V). We did not obtain any statistically significant data for the linear correlations between IR and the molecular profile, whether referring to the luminal subtypes (Luminal A and Luminal B) or to the non-luminal ones (HER2+ and TNBC), with p > 0.05, 0.201 [0.88, 0.167]; z = 1.82. [ABSTRACT FROM AUTHOR]

Background/Aim: In rectal cancer surgery, anastomotic leakage (AL) is the most important complication and has a reported frequency of 11-15%. The causes of AL leakage are complex, and AL prevention should be performed in multiple directions. Thus, this study examined the usefulness of the comprehensive and multifaceted AL preventive measures. Patients and Methods: In total, 164 rectal surgery patients who had low rectal staple anastomosis below the peritoneal reflection were enrolled. The patients were divided into two groups: (i) the multifaceted AL prevention group (MP group, n=34) and (ii) the insufficient AL prevention group (IP group, n=130). Multifaceted AL prevention was defined as intestinal blood flow evaluated via indocyanine green (ICG)-fluorescence imaging (FI), the use of a single-staple technique (SST) without intersecting stapling lines or "dog ears", the use of transanal suture reinforcement according to the air leakage test, and the use of a transanal tube for anatomical decompression and a diverting stoma for diverting the fecal stream. The AL rates were retrospectively compared between the two groups. The data are expressed as the median and interquartile range. Results: The rate of AL was significantly lower in the MP group (0%) than in the IP group (11.54%) (p=0.0423). Conclusion: Multifaceted AL prevention, including ICG-FI and SST, achieved a zero incidence of AL. Multifaceted prevention significantly lessened AL more than inadequate prevention did. Therefore, if the weight of each preventive measure cannot be clearly identified, to avoid AL, it is important to take all preventive measures from multiple aspects. [ABSTRACT FROM AUTHOR]

It is observed that the locations of the most functional lymphatic vessels in the lymphedematous limbs can differ significantly from those in healthy limbs. The aim of this study was to elucidate the lymphatic map of lymphedematous limbs. We retrospectively analyzed 59 patients (118 limbs) with lower limb lymphedema. Fifty-five were women and four were men. The mean age and duration of lymphedema was 62.4 and 7.7 years, respectively. For the lateral thigh lymphosome, we injected indocyanine green (ICG) at the lateral knee and measured the distance (Dt) between the anterior superior iliac spine (ASIS) and the point where the lymphatic vessels crossed the reference line (the line connecting the ASIS and the patellar center). For the lateral calf lymphosome, we injected ICG at the lateral ankle and measured the distance (Dc) between the inferior patellar border and the point where the lymphatic vessels crossed the reference line (the anterior border of the tibia). In the lateral thigh, the mean Dt was 30.4 ± 0.6 cm (range, 0–41 cm) and the distribution peaked at approximately 30 cm from the ASIS. In the calf, the mean Dc was 13.1 ± 0.9 cm (range, −11 to 32 cm). The distribution of lymphatic vessel locations was highly variable. We could establish the lymphatic map in the lymphedematous legs. The distribution of lymphatic vessels in the thigh and lower legs had one and two peaks, respectively. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node (SLN) biopsy by a dual technique using technetium and methylene blue (MB) is a standard method of assessing the axilla in node-negative breast cancer. However, technetium has few drawbacks and not easily available, especially during the situation like COVID-19 pandemic. This warrants for the development of alternate techniques of SLN biopsy replacing the technetium. Methods: A retrospective study of prospectively entered data was collected from 1st of January to 31st of December 2020 in a tertiary cancer center in India. A total of 86 node-negative breast cancer patients, who underwent SLN biopsy using dual technique either by technetium and MB or indocyanine green (ICG) and MB were studied. There were 52 patients in technetium and MB group and 34 patients in the indocyanine green and MB group. Results: There was no statistically significant difference in age, quadrant of a tumor, type of surgery, histopathology, grade, size of tumor, and hormone receptor status between the groups. Both techniques had similar identification rates, mean sentinel nodes removed, and SLN positivity rate. Conclusion: In circumstances where technetium is not available, ICG with MB can be considered as a safe alternative technique for SLN biopsy. [ABSTRACT FROM AUTHOR]

Reactive oxygen species (ROS) are widely considered to the effective therapeutics for fighting bacterial infections especially those associated with biofilm. However, biofilm microenvironments including hypoxia, limited H 2 O 2 , and high glutathione (GSH) level seriously limit the therapeutic efficacy of ROS-based strategies. Herein, we have developed an acidic biofilm microenvironment-responsive antibacterial nanoplatform consisting of copper-dopped bovine serum albumin (CBSA) loaded with copper peroxide (CuO 2) synthesized in situ and indocyanine green (ICG). The three-in-one nanotherapeutics (CuO 2 /ICG@CBSA) are capable of releasing Cu2+ and H 2 O 2 in a slightly acidic environment, where Cu2+ catalyzes the conversion of H 2 O 2 into hydroxyl radical (•OH) and consumes the highly expressed GSH to disrupt the redox homeostasis. With the assistance of an 808 nm laser, the loaded ICG not only triggers the production of singlet oxygen (1O 2) by a photodynamic process, but also provides photonic hyperpyrexia that further promotes the Fenton-like reaction for enhancing •OH production and induces thermal decomposition of CuO 2 for the O 2 -self-supplying 1O 2 generation. The CuO 2 /ICG@CBSA with laser irradiation demonstrates photothermal-augmented multi-mode synergistic bactericidal effect and is capable of inhibiting biofilm formation and eradicating the biofilm bacteria. Further in vivo experiments suggest that the CuO 2 /ICG@CBSA can effectively eliminate wound infections and accelerate wound healing. The proposed three-in-one nanotherapeutics with O 2 /H 2 O 2 -self-supplied ROS generating capability show great potential in treating biofilm-associated bacterial infections. Here, we have developed an acidic biofilm microenvironment-responsive nanoplatform consisting of copper-dopped bovine serum albumin (CBSA) loaded with copper peroxide (CuO 2) synthesized in situ and indocyanine green (ICG). The nanotherapeutics (CuO 2 /ICG@CBSA) are capable of releasing Cu2+ and H 2 O 2 in an acidic environment, where Cu2+ catalyzes the conversion of H 2 O 2 into •OH and consumes the overexpressed GSH to improve oxidative stress. With the aid of an 808 nm laser, ICG provides photonic hyperpyrexia for enhancing •OH production, and triggers O 2 -self-supplying 1O 2 generation. CuO 2 /ICG@CBSA with laser irradiation displays photothermal-augmented multi-mode antibacterial and antibiofilm effect. Further in vivo experiments prove that CuO 2 /ICG@CBSA effectively eliminates wound infection and promotes wound healing. The proposed three-in-one nanotherapeutics show great potential in treating biofilm-associated bacterial infections. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy is associated with an incidence of postoperative complications of approximately 41%. One of the most severe complications is a postoperative pancreatic fistula. The exact cause of postoperative fistula development is still unknown, but it appears to be multifactorial. Proper perfusion of pancreatic remnant is essential for the healing of pancreaticojejunostomy. To date, there is no method to reliably evaluate the vascular supply of the remnant. One of the methods for the assessment of organ perfusion is the indocyanine green fluorescence. This study aims to determine if indocyanine green fluorescence is a reliable method to measure the perfusion of the post-resection pancreatic remnant. The secondary outcome is to determine if intraoperative evaluation of the vascular supply of the post-resection remnant may predict the increased risk of postoperative pancreatic fistula development. Methods: This study is designed as a prospective, observational study. All consecutive patients undergoing open or robotic pancreaticoduodenectomies at our department during the 1st May 2024-31st December 2026 period will be enrolled. The exclusion criteria are an allergy to indocyanine green and refusal by the patient. The adequacy of the vascular supply of the post-resection pancreatic remnant will be intraoperatively evaluated using a fluorescence detector. Patients will be divided into two groups: Those with high risk of pancreatic fistula development and those with low risk. The incidence of pancreatic fistulas in both groups is to be compared. Postoperative data including morbidity, mortality, hospital stay, intensive care unit stay and postoperative fistula development will be collected. Discussion: If an intraoperative assessment of the perfusion of post-resection pancreatic remnant using indocyanine green is proven to be a suitable method to estimate the increased risk of the pancreatic fistula, the list of the existing known risk factors could be expanded. In the most high-risk patients the modification of the surgical procedure could be considered. Trial registration: Number: NCT06198400 ClinicalTrials.Gov. Date 08.01.2024. [ABSTRACT FROM AUTHOR]

Indocyanine green (ICG) fluorescence image guidance (I-FIGS) is increasingly used in liver surgery. Several regimens have been described regarding the optimum timing and dose of administration. This study presents our early experience with utilising monochromatic Colour Segmented Fluorescence (CSF)-mode and same-day administration of low-dose-ICG in the resection of liver tumours. Between November 2020 and March 2022, I-FIGS was used in 15 patients with suspected liver tumours. ICG was administered intravenously at 0.02 to 0.05 mg/kg dose 2–3 h before surgery. ICG camera was switched to CSF-grey-scale mode to visualise the tumour and to avoid the interference of the green background liver. Using the SPY-CSF mode, the image was scaled to near-infra-red (NIR) fluorescence intensity to accurately identify the tumours and resection margins. Fifteen patients (eight males) with a median age of 71 years (range: 36–86) underwent I-FIGS. Of these, 67% underwent laparoscopic liver surgery, 78% had non-anatomical resections, and 33% underwent redo liver surgery. The mean tumour size was 40.6 mm (SD+/-41 mm). The median number of tumours was two (1–7). All colorectal liver metastases (CRLM) had a signet ring appearance. Hepatocellular carcinomas (HCC) showed partial fluorescence. Tumours were well/moderately differentiated, with CRLM in 86% and HCC in two patients. The R0 resection rate was 72%. In our experience, low-dose-ICG administered at least 2–3 h before surgery can identify liver tumours and their margins in CSF-grey-scale mode. Further research is needed to evaluate its role in reducing R1 resection rates and surgical outcomes. [ABSTRACT FROM AUTHOR]

The immune system plays an important role in fracture healing, by modulating the pro-inflammatory and anti-inflammatory responses occurring instantly upon injury. An imbalance in these responses can lead to adverse outcomes, such as non-union of fractures. Implants are used to support and stabilize complex fractures. Biodegradable metallic implants offer the potential to avoid a second surgery for implant removal, unlike non-degradable implants. However, considering our dynamic immune system it is important to conduct in-depth studies on the immune response to these implants in living systems. In this study, we investigated the immune response to Mg and Mg-10Gd in vivo in a rat femur fracture model with external fixation. In vivo imaging using liposomal formulations was used to monitor the fluorescence-related inflammation over time. We combine ex vivo methods with our in vivo study to evaluate and understand the systemic and local effects of the implants on the immune response. We observed no significant local or systemic effects in the Mg-10Gd implanted group compared to the SHAM and Mg implanted groups over time. Our findings suggest that Mg-10Gd is a more compatible implant material than Mg, with no adverse effects observed in the early phase of fracture healing during our 4-week study. Degradable metallic implants in form of Mg and Mg-10Gd intramedullary pins were assessed in a rat femur fracture model, alongside a non-implanted SHAM group with special respect to the potential to induce an inflammatory response. This pre-clinical study combines innovative non-invasive in vivo imaging techniques associated with multimodal, ex vivo cellular and molecular analytics. The study contributes to the development and evaluation of degradable biometals and their clinical application potential. The study results indicate that Mg-10Gd did not exhibit any significant harmful effects compared to the SHAM and Mg groups. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Precise resection of orbital tumors is a critically important but elusive issue. Fluorescence imaging in the near‐infrared II window (NIR‐II) holds the potential to provide the surgeons with real‐time identification for orbital tumors. Here, for the first time, we evaluated the feasibility and clinical value of NIR‐II fluorescence imaging in orbital tumor surgery. To establish the method of NIR‐II fluorescence imaging for orbital tumors, we developed a NIR‐II fluorescence imaging system and indocyanine green (ICG) served as the fluorescent contrast agent. Twenty‐two patients diagnosed with orbital tumors and scheduled for standard‐of‐care surgery were enrolled in this study. Time‐course NIR‐II fluorescence imaging of two patients with superficial orbital tumors showed the optimum imaging time was 2 h post injection of ICG. Fifteen patients were allocated for diagnostic test, which showed that both the in situ and ex vivo NIR‐II fluorescence imaging showed better sensitivity and specificity than the surgeon judgment. In the feasibility trial of the remaining five patients, the surgeon encountered 34 suspicious regions and surgical decisions were changed nine times due to NIR‐II fluorescence imaging. The resultant seven additional resections were justified by histopathology and the two conservative treatments did not result in recurrence. Based on these findings, we suggested that ICG‐based NIR‐II fluorescence imaging was feasible to guide precise resection of orbital tumors. A future randomized controlled trial with a larger cohort is encouraged to further verify the clinical value.

Introduction: Immediate post-mastectomy breast reconstruction offers benefits; however, complications can compromise outcomes. Intraoperative indocyanine green fluorescence angiography (ICGFA) may mitigate perfusion-related complications (PRC); however, its interpretation remains subjective. Here, we examine and develop methods for ICGFA quantification, including machine learning (ML) algorithms for predicting complications. Methods: ICGFA video recordings of flap perfusion from a previous study of patients undergoing nipple-sparing mastectomy (NSM) with either immediate or staged immediate (delayed by a week due to perfusion insufficiency) reconstructions were analysed. Fluorescence intensity time series data were extracted, and perfusion parameters were interrogated for overall/regional associations with postoperative PRC. A naïve Bayes ML model was subsequently trained on a balanced data subset to predict PRC from the extracted meta-data. Results: The analysable video dataset of 157 ICGFA featured females (average age 48 years) having oncological/risk-reducing NSM with either immediate (n=90) or staged immediate (n=26) reconstruction. For those delayed, peak brightness at initial ICGFA was lower (p

Abstract Background Hepatectomy stands as a curative management for liver cancer. The critical factor for minimizing recurrence rate and enhancing overall survival of liver malignancy is to attain a negative margin hepatic resection. Recently, Indocyanine green (ICG) fluorescence imaging has been proven implemental in aiding laparoscopic liver resection, enabling real-time tumor identification and precise liver segmentation. The purpose of this study is to conduct a systematic review and meta-analysis to ascertain whether ICG-guided laparoscopic hepatectomy yields a higher incidence of complete tumor eradication (R0) resections. Methods The search encompassed databases such as PubMed, Cochrane Library database, Scopus, ScienceDirect, and Ovid in April 2024, in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving patients with malignant liver lesions who underwent ICG-guided laparoscopic hepatectomy and reported R0 resection outcomes were eligible for inclusion in this review. Results In a total of seven studies, involving 598 patients, were included in the meta-analysis. The ICG demonstrated a significantly elevated R0 resection rate compared to the non-ICG group [98.6% (359/364) vs. 93.1% (339/364), odds ratio (OR) = 3.76, 95% confidence intervals (CI) 1.45–9.51, P = 0.005]. Notably, no heterogeneity was observed (I 2 = 0%, P = 0.5). However, the subtype analysis focusing on hepatocellular carcinoma [98.2% (165/168) vs. 93.6% (161/172), OR = 3.34, 95% CI 0.94–11.91, P = 0.06) and the evaluation of margin distance (4.96 ± 2.41 vs. 2.79 ± 1.92 millimeters, weighted mean difference = 1.26, 95% CI -1.8-4.32, P = 0.42) revealed no apparent differences. Additionally, the incidence of overall postoperative complications was comparable between both groups, 27.6% (66/239) in the ICG group and 25.4% (75/295) in the non-ICG group (OR = 0.96, 95% CI 0.53–1.76, P = 0.9). No disparities were identified in operative time, intraoperative blood loss, postoperative blood transfusion, and length of hospital stay after the surgery. Conclusions The implementation of ICG-guided laparoscopic hepatectomy can be undertaken with confidence, as it does not compromise either intraoperative or postoperative events. Furthermore, the ICG-guided approach is beneficial to achieving a complete eradication of the tumor during hepatic resection. Trial registration PROSPERO registration number CRD42023446440.

Background: Hepatectomy stands as a curative management for liver cancer. The critical factor for minimizing recurrence rate and enhancing overall survival of liver malignancy is to attain a negative margin hepatic resection. Recently, Indocyanine green (ICG) fluorescence imaging has been proven implemental in aiding laparoscopic liver resection, enabling real-time tumor identification and precise liver segmentation. The purpose of this study is to conduct a systematic review and meta-analysis to ascertain whether ICG-guided laparoscopic hepatectomy yields a higher incidence of complete tumor eradication (R0) resections. Methods: The search encompassed databases such as PubMed, Cochrane Library database, Scopus, ScienceDirect, and Ovid in April 2024, in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving patients with malignant liver lesions who underwent ICG-guided laparoscopic hepatectomy and reported R0 resection outcomes were eligible for inclusion in this review. Results: In a total of seven studies, involving 598 patients, were included in the meta-analysis. The ICG demonstrated a significantly elevated R0 resection rate compared to the non-ICG group [98.6% (359/364) vs. 93.1% (339/364), odds ratio (OR) = 3.76, 95% confidence intervals (CI) 1.45–9.51, P = 0.005]. Notably, no heterogeneity was observed (I2 = 0%, P = 0.5). However, the subtype analysis focusing on hepatocellular carcinoma [98.2% (165/168) vs. 93.6% (161/172), OR = 3.34, 95% CI 0.94–11.91, P = 0.06) and the evaluation of margin distance (4.96 ± 2.41 vs. 2.79 ± 1.92 millimeters, weighted mean difference = 1.26, 95% CI -1.8-4.32, P = 0.42) revealed no apparent differences. Additionally, the incidence of overall postoperative complications was comparable between both groups, 27.6% (66/239) in the ICG group and 25.4% (75/295) in the non-ICG group (OR = 0.96, 95% CI 0.53–1.76, P = 0.9). No disparities were identified in operative time, intraoperative blood loss, postoperative blood transfusion, and length of hospital stay after the surgery. Conclusions: The implementation of ICG-guided laparoscopic hepatectomy can be undertaken with confidence, as it does not compromise either intraoperative or postoperative events. Furthermore, the ICG-guided approach is beneficial to achieving a complete eradication of the tumor during hepatic resection. Trial registration: PROSPERO registration number CRD42023446440. [ABSTRACT FROM AUTHOR]

Background: In recent years, with the continuous development of fluorescence imaging technology, research on its application in pancreatic diseases has surged. This area is currently of high research interest and holds the potential to become a non-invasive and effective tool in the diagnosis and treatment of pancreatic diseases. The objective of this study is to explore the hotspots and trends in the field of fluorescence imaging technology applications in pancreatic diseases from 2003 to 2023 through bibliometric and visual analysis. Methods: This study utilized the Web of Science (core collection) to identify publications related to the application of fluorescence imaging technology in pancreatic diseases from 2003 to 2023. Tools such as CiteSpace (V 6.2.R6), VOSviewer (v1.6.20), and R Studio (Bibliometrix: R-tool version 4.1.4) were employed to analyze various dimensions including publication count, countries, institutions, journals, authors, co-cited references, keywords, burst words, and references. Results: A comprehensive analysis was conducted on 913 papers published from January 1, 2003, to December 1, 2023, on the application of fluorescence imaging technology in pancreatic diseases. The number of publications in this field has rapidly increased, with the United States being the central hub. The University of California, San Diego emerged as the most active institution. "Biomaterials" was identified as the most influential journal. Authors with the most publications and the highest average citations per article are Hoffman, Robert M. and Luiken, George A., respectively. Keywords such as pancreatic cancer, cancer, expression, indocyanine green, and nanoparticles received widespread attention, with indocyanine green and nanoparticles being current active research hotspots in the field. Conclusion: This study is the first bibliometric analysis in the field of fluorescence imaging technology applications in pancreatic diseases. Our data will facilitate a better understanding of the developmental trends, identification of research hotspots, and direction in this field. The findings provide practical information for other scholars to grasp key directions and cutting-edge insights. [ABSTRACT FROM AUTHOR]

Simple Summary: A positive sentinel lymph node biopsy of cutaneous melanoma patients has a substantial impact on subsequent treatment decisions. The standard of care approach to identify the sentinel lymph node is technetium (Tc)-based lymphoscintigraphy. This technique comes with a radiation exposure and high costs. Indocyanine green (ICG)-based near-infrared fluorescence imaging could be an alternative if demonstrated to have a comparable diagnostic accuracy. Therefore, a systematic literature review and meta-analysis were conducted considering studies comparing the accuracy of ICG and Tc for intraoperative guidance. Within the seven included studies, no significant differences between the two modalities were found regarding the identification of metastatic patients or the false negative rate. ICG may be a non-inferior alternative to Tc for intraoperative identification of the sentinel lymph node in cutaneous melanoma patients. The standard of care approach to identify sentinel lymph nodes (SLNs) in clinically non-metastatic cutaneous melanoma patients is technetium (Tc)-based lymphoscintigraphy. This technique is associated with radiation exposure, a long intervention time, high costs, and limited availability. Indocyanine green (ICG)-based near-infrared fluorescence imaging offers a potential alternative if proven to be of comparable diagnostic accuracy. While several clinical cohorts have compared these modalities, no systematic review exists that provides a quantitative analysis of their results. Hence, a systematic literature review was conducted in December 2023 considering clinical studies comparing the diagnostic accuracy of ICG and Tc for sentinel lymph node biopsy in cutaneous melanoma patients. Three hundred nineteen studies were identified and further screened in accordance with the PRISMA 2020 guidelines, resulting in seven studies being included in the final meta-analysis. Tc identified a significantly higher number of SLNs and metastatic SLNs in prospective studies only. However, in the overall meta-analysis of all included comparative studies, no significant differences were found regarding the identification of metastatic patients or the false negative rate (FNR). ICG may be a non-inferior alternative to Tc for intraoperative guidance in sentinel lymph node biopsy in cutaneous melanoma patients. Future randomized controlled trials are needed, especially regarding the preoperative, transcutaneous identification of the affected lymph node basin. [ABSTRACT FROM AUTHOR]

Purpose: Some prospective trials have demonstrated the feasibility of sentinel node (SN) biopsy in gastric cancer (GC) surgery. This study aimed to identify the appropriate concentration settings for the intraoperative injection of indocyanine green (ICG) for SN biopsy. Methods: Before the clinical studies, porcine model experiments explored the optimal concentration of ICG injected intraoperatively. Next, nine GC patients were enrolled in the clinical research. ICG (0.5 ml) was injected intraoperatively into four quadrants of the submucosa around the tumor at various concentrations (0.5, 0.25, and 0.1 mg/ml). The lymphatic basin dissection method was applied to the ICG-positive lymphatic areas. The number and location of the lymphatic basins and positive nodes were recorded intraoperatively. Results: In the porcine model, the visibility gradually became clear at an ICG concentration higher than 0.1 mg/ml. In the clinical study, the average number of detected lymphatic basins was 3.3, 1.7, and 1.7, respectively. The mean number of detected SNs was 14.7, 6.7, and 4.0, respectively. Conclusion: To improve the reproducibility of SN biopsy, it is essential to prepare the correct concentration setting of ICG. Under current conditions in which ICG is injected intraoperatively, a 0.1 mg/ml concentration setting of ICG may be necessary and sufficient for SN identification. [ABSTRACT FROM AUTHOR]

Although the usefulness of lymphaticovenous anasotmosis (LVA) for lymphedema has been reported, it is difficult to determine where the LVA is to be performed, especially for inexperienced surgeons. This study aimed to establish a map of the LVA site. A total of 105 limbs from 64 patients who underwent lower limb LVA were retrospectively reviewed. Multi-lymphosome indocyanine green (ICG) lymphography (in 35 patients) and lymphatic ultrasound (in all patients) were performed preoperatively and the incision site was determined where dilated lymph vessels and appropriate veins were located in close proximity. The LVA location was identified using a post-operative photograph. Additionally, the degree of lymphatic degeneration at the LVA site was recorded based on the normal, ectasis, contraction, and sclerosis type (NECST) classification. A total of 206 skin incisions were analyzed. Among them, 161 (75.9%) were medial and 45 (21.2%) were lateral. Among the 85 sites on the calf, 52 (61.2%) were medial and 33 (38.8%) were lateral. Among the 117 sites on the thigh, 106 (90.6%) were medial and 11 (9.4%) were lateral. As the severity of lymphedema progressed, the probability of performing LVA on the lateral calf increased. Among the 202 locations where LVA was performed on the thigh and lower leg, ectasis type was found in 164 sites (81.2%). We established an LVA map of the legs based on multi-lymphosome ICG lymphography and lymphatic ultrasound data. Using this LVA map, surgeons can easily predict the location of lymph vessels, thereby improving the success rate of LVA. [ABSTRACT FROM AUTHOR]

Background: Intraoperative indocyanine green (ICG) fluorescence imaging has been shown to be a new and innovative way to illustrate the optimal resection margin in hepatectomy for hepatocellular carcinoma. This study investigated its accuracy in resection margin determination by looking into the correlation of ICG intensity gradients with pathological examination results of resected specimens. Methods: This was a prospective, single-center, non-randomized controlled study. Patients who had liver tumors indicating liver resection were recruited. The hypothesis was that the use of intraoperative near-infrared/ICG fluorescence imaging would be a promising guiding tool for removing hepatocellular carcinoma with a better resection margin. Patients were given ICG (0.25 mg/kg) 1 day before operation. Resected specimens were inspected under a fluorescent imaging system. Biopsies were taken from tumors and normal tissue. Color signals obtained from ICG fluorescence imaging were compared with biopsies for analysis. Results: Twenty-two patients were recruited for study. The median size of their tumors was 2.25 cm. One patient had resection margin involvement. Under ICG fluorescence, the tumors typically lighted up as yellow color, wrapped by a zone of green color. Tumors of 17 patients (77.3%) displayed yellow color and were confirmed malignancy, while tumors of 12 patients (54.5%) displayed green color and were confirmed malignancy. Receiver operating characteristic curve was used to measure the sensitivity and specificity of the green color to look for a clear resection margin. The area under the curve was 85.3% (p = 0.019, 95% confidence interval 0.696–1.000), with a sensitivity of 0.706 and specificity of 1.000. Conclusion: The use of ICG fluorescence can be helpful in determining resection margins. Resection of tumor should include complete resection of the green zone shown in the fluorescence image. [ABSTRACT FROM AUTHOR]

Introduction: Use of indocyanine green (ICG) with near‐infrared fluorescence (NIRF) has been demonstrated to be an effective tool for intraoperative assessment of bowel and ureteric vascularity. This study aimed to evaluate the impact of ICG on postsurgical outcomes such as anastomotic bowel leak and uretero‐enteric stricture formation during robot‐assisted cystectomy (RAC) and intracorporeal urinary diversion (ICUD). Methods: We identified 238 patients who underwent RAC at the University of Louisville between September 2012 and August 2021. Patients were divided into two groups based on the utilization of ICG. Demographic, perioperative outcomes, and rate of anastomotic bowel leak were compared. Results: In total, 138 patients were in the ICG group and 100 patients were in the non‐ICG group. More intracorporeal urinary diversions and more simple cystectomies were observed in the ICG group (p < 0.001 and p = 0.015, respectively). The ICG group patients initiated an oral diet sooner than the control group (4.9 vs. 7.1 days, p < 0.001). The mean length of stay of the ICG group was shorter than the non‐ICG group (8.3 vs. 12.8 days, p < 0.001). The rate of postoperative ileus was not significantly different between cohorts. No patients in the ICG group experienced a bowel leak compared with five patients in the non‐ICG group (p = 0.008). Conclusions: In our study, the use of ICG for intraoperative assessment of bowel and ureteric vascularity was associated with earlier bowel recovery and a shorter length of stay. It was also significantly correlated with a lower rate of anastomotic bowel leak. [ABSTRACT FROM AUTHOR]

In pediatric colorectal surgery, achieving and visualizing adequate perfusion during complex reconstructive procedures are paramount to ensure postoperative success. However, intraoperative identification of proper perfusion remains a challeng. This review synthesizes findings from the literature spanning from January 2010 to March 2024, sourced from Medline/PubMed, EMBASE, and other databases, to evaluate the role of indocyanine green (ICG) fluorescence imaging in enhancing surgical outcomes. Specifically, it explores the use of ICG in surgeries related to Hirschsprung disease, anorectal malformations, cloacal reconstructions, vaginal agenesis, bladder augmentation, and the construction of antegrade continence channels. Preliminary evidence suggests that ICG fluorescence significantly aids in intraoperative decision-making by improving the visualization of vascular networks and assessing tissue perfusion. Despite the limited number of studies, initial findings indicate that ICG may offer advantages over traditional clinical assessments for intestinal perfusion. Its application has demonstrated a promising safety profile in pediatric patients, underscoring the need for larger, prospective studies to validate these observations, quantify benefits, and further assess its impact on clinical outcomes. The potential of ICG to enhance pediatric colorectal surgery by providing real-time, accurate perfusion data could significantly improve surgical precision and patient recovery. [ABSTRACT FROM AUTHOR]

Introduction: Mediastinal teratomas present unique surgical challenges during resection. Here, we describe a novel use of Indocyanine Green (ICG) for real time identification of tumor borders and resection planes of a malignant mediastinal teratoma and right lung nodule. Case presentation: A 13-year-old male with Klinefelter's Syndrome presented for right upper quadrant pain, difficulties walking and eating, and with elevated alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (β-hCG). A CT scan demonstrated a lobulated right-sided mediastinal mass, as well as an isolated right middle lobe lung nodule. The patient underwent elective resection. He was injected with 3 mg/kg ICG one day prior to his planned operation. After median sternotomy, ICG imaging aided in the identification of the mediastinal mass, tumor borders and resection planes, particularly where the tumor was continuous with the right lobe of the thymus and along the deeper structures of the mediastinum. The right lung nodule was similarly visualized and resected. Pathologic examination of the mass revealed components of immature teratoma, choriocarcinoma, yolk sac tumor, and seminoma. The lung nodule demonstrated only chronic inflammation and compressive atelectasis from the tumor's mass effect. The patient recovered well and was discharged on post operative day 6. He follows with the oncology team for outpatient chemotherapy. Conclusion: Though rare, teratomas in the mediastinum can occasionally be malignant and have the potential to involve adjacent structures, thereby creating a technical challenge at surgery. This case demonstrates the usefulness of ICG for intraoperative visualization of tumors to facilitate safe resection and improved outcomes.