Table 3.
Study outcome summary separated in different surgical specialties.
| References |
Study design
(data collection) |
Indication
(Country) |
Number children/adults | Age |
ICG dose,
route administration, timing |
Outcomes |
|---|---|---|---|---|---|---|
| Pediatric surgery ( n = 29) | ||||||
| Bada-Bosch et al. (12) | Descriptive study | Splenic cyst (Spain) | 1 | 13 y | 0.2 mg/kg IV, intraoperatively | Guides laparoscopic partial splenectomy |
| Bryant et al. (13) | Descriptive study | Gallbladder duplication (United States) | 1 | 17y | Not specified | Not able to provide adequate details to assist in dissection |
| Calabro et al. (14) | Descriptive study (prospective) | Lap cholecystectomy (United States) | 31 | 6–18y | 2.5 mg IV, intraoperatively before surgical incision | Useful for Calot triangle dissection |
| Chang et al. (15) | Descriptive study | Post-operative chylothorax (Taiwan) | 1 | 3m | 2 ml of Diagnogreen 0.5% SC, bilateral inguinal | Successful visualization of leak |
| Chen-Yoshikawa et al. (16) | Descriptive study | Hepatoblastoma lung metastasis (Japan) | 1 | 3y | 0.5 mg/kg ICG IV, 24h pre-op | 2y without recurrence |
| Chung et al. (18) | Descriptive study | Hepatocellular carcinoma (China) | 1 | 9y | 0.5 mg/kg ICG IV, 24h pre-op | Useful for laparoscopic hepatectomy—identification of tumor, adequate resection margins |
| Esposito et al. (22) | Descriptive study (ambispective) | Pediatric minimally invasive procedures (Italy) | 46 | 8–18y | Depends on procedure: 0.3–0.5 mg/kg IV (abdominal procedures), 6 mg intra-testicular (varicocelectomy) | Success for lap procedures: cholecystectomy, varicocelectomy, abdominal mass excision, nephrectomy |
| Esposito et al. (23) | Descriptive study (retrospective) | Lap cholecystectomy (Italy) | 215* | 5–17y | 0.4 mg/kg IV, 18h pre-op | Lower average operative time with ICG and quicker to view critical view of safety |
| Esposito et al. (26) | Descriptive study (ambispective) | Varicocelectomy, nephrectomy, renal cyst deroofing, cholecystectomy, lymphoma and abdominal tumor (Italy) | 76 | 1–18y | 0.25–0.5 mg/ml/kg IV, intra-testicular or intra-lesion; 15–18h pre-op for cholecystectomies | No clear demarcation between cystic malformation and normal parenchyma (thoracoscopic lobectomy) |
| Esposito et al. (27) | Descriptive study (retrospective) | Simple renal cysts (Italy) | 13† | 8y (5–15 y) | 0.35 mg/kg IV, intraoperatively | Guides cyst evacuation and deroofing |
| Fernandez-Bautista et al. (28) | Case series | Lap procedures: aortocoronary fistula, varicocelectomy, cholecystectomy, nephrectomy (Spain) | 5 | 3–14 y | 0.2 mg/kg IV | Safe dissection of vascular anatomy |
| Fung et al. (29) | Descriptive study | Pulmonary nodule (tuberculosis) (China) | 1 | 4y | 0.5 ml intra-lesion, 1h pre-op CT-guided | Confirmation of complete excision and localization of nodule |
| Guillen et al. (31) | Descriptive study (ambispective) | Surgical anatomy (biliary tract, oncology, pulmonary nodules, esophagus and duodenal atresia) (Spain) | 20 | 10.9y (7d−19y) | 0.15 mg/kg to 3 mg/kg IV, 24h pre-op to intra-op depending on indication | No complication, relevant information in 90% of the cases |
| Hirayama et al. (34) | Descriptive study | Kasai procedure for biliary atresia (Japan) | 5 | 31–75d | 0.1 mg/kg IV, 24h preop | Intra-op detection of bile leak. Fluorescence detection in feces postop.‡ |
| Iinuma et al. (37) | Descriptive study | Intestinal ischemia (Japan) | 1 | 15y | 25 mg IV | Detection of abnormal vascular flow |
| Kitagawa et al. (44) | Descriptive study (ambispective) | Hepatoblastoma with pulmonary metastases (Japan) | 10 | 1–11y | 0.5 mg/kg IV, 24h preop | Detection of nodules not seen on palpation or CT scan, but 29/250 false positive nodules |
| Mihara et al. (47) | Descriptive study (retrospective) | Chylous pleural effusion, ascite (Japan) | 8 | 25d−7m | 0.1 ml of Diagnogreen 0.05%, bilateral feet and hands | Useful for lymphography+ lymphaticovenous anastomosis (LVA). Limitations: LVA had no effect in 2 patients. |
| Mitani et al. (48) | Descriptive study | Hepatoblastoma (Japan) | 1 | 32m | 0.5 mg/kg IV, 2 days preop | Successful identification of hepatoblastoma, no recurrence at 13m |
| Otake et al. (51) | Descriptive study | Chylous ascites (Japan) | 1 | 13y | 5 ml, popliteal fossa | No recurrence at 6m |
| Rentea et al. (53) | Descriptive study (retrospective) | Anorectal malformation, cloaca, Hirschsprung (United States) | 13 | 1.9y (0.5–7.8y) | 0.2 mg/kg ICG IV | Change in the operative plan in 4/12 (31%) |
| Shafy et al. (55) | Descriptive study (retrospective) | Colorectal surgeries, cholecystectomy, renal procedures, and more (United States) | 100 | Median 12 y | 0.5–2.5 mg/ml (depending on weight and procedure) | Proved safety with repeated injections of ICG |
| Shibasaki et al. (56) | Descriptive study | Congenital pleural effusion and ascites (Japan) | 10 | 1–275d | 0.25 mg SC | Can be performed at bedside, consistent with clinical course. Change in skin color (n = 1). Limitations: only visualize superficial lymphatic vessels (< 2 cm) |
| Shirotsuki et al. (58) | Descriptive study (retrospective) | Tracheoesophageal fistula (Japan) | 10 | 1–10d | 0.025 mg inter-toe injection, 1h preop | |
| Souzaki et al. (59) | Descriptive study (retrospective) | Hepatoblastoma with pulmonary metastases (Japan) | 5 | 12–36m | 0.5 mg/kg IV, 90.5 +/- 33.7 h before hepatectomy/liver transplant and 21.8 +/- 3.4 h before lung resection | Successful detection of 1.2 mm tumors and ad 6 mm from lung surface. Limitations: 1 false positive pulmonary lesion |
| Takahashi et al. (64) | Descriptive study | Recurrent hepatoblastoma with peritoneal metastases (Japan) | 1 | 14 y | 0.5 mg/kg IV, 72h preop | No recurrence at 30m |
| Yada et al. (69) | Descriptive study | Stoma closure (Japan) | 2 | 11m, 16m | 0.3 mg/kg IV | Evaluation of intestinal blood flow and postoperative bowel function (detection of ICG in stools) |
| Yamamichi et al. (70) | Descriptive study | Hepatoblastoma (Japan) | 3 | 1–6 y | 0.5 mg/kg IV, 3–4 days preop | Cannot detect lesions distant from liver surface and < 3 mm |
| Yanagi et al. (71) | Analytic cohort study (retrospective) | Biliary atresia (Japan) | 10 | Mean : 74.8d (48–122d) | 0.5 mg/kg IV, 23h pre-op | Useful for observing biliary flow |
| Yokoyama et al. (72) | Descriptive study | Refractory chylous ascites (Japan) | 1 | 2.5m | 0.1 mL SC, bilateral (dorsum of each foot) | Confirmation of lymphatic duct and made treatment possible |
| Pediatric neurosurgery ( n = 12) | ||||||
| Ambekar et al. (9) | Descriptive study (retrospective) | Moyamoya disease (India) | 6/13 | Median: 11y | 0.3 mg/kg IV | Confirmation of patency of superficial temporary artery - middle cerebral artery anastomoses |
| Asayama et al. (10) | Descriptive study | Skull bone tumor (Japan) | 2/4 | 7y, 11y | 0.2 mg/kg IV | Useful for tumors extending under bone surface, no recurrence at 1.5–2y |
| Hori et al. (36) | Descriptive study (prospective) | Moyamoya disease (Japan) | 9/13 | 4–69y Mean age for ped patients: 12.8y +/− 5y | Not specified | Confirm patency and evaluate the anterior branch of the middle meningeal artery for preservation, good correlation with postop imaging. No recurrence at mean FU: 16m |
| Horie et al. (35) | Analytic cohort study (prospective) | Moyamoya disease (Japan) | 14/22 | Mean age for ped patients: 9.9 +/− 4y | 12.5 mg IV | May have potential to predict postop hyperperfusion in Moyamoya disease |
| Kim et al. (43) | Descriptive study | Complex vascular neoplastic lesions (United States) | 1/4 | 16y | 25 mg IV | Confirmation of occlusion of an artery branch |
| Nossek et al. (49) | Descriptive study | Cerebral mycotic aneurysm (United States) | 1 | 17y | Not specified | Intraop demonstration of complete occlusion, no recurrence at 2m |
| Sanchez-Fernandez et al. (54) | Descriptive study | Refractory subdural empyema (Spain) | 1 | 11y | 2.5 mg/kg IV | Preservation of viable parenchyma |
| Sugimoto et al. (60) | Descriptive study | Intracranial pial arteriovenous fistula (Japan) | 1 | 3y | 1.5 mg IV | Identification of fistulous shunting points, no recurrence at 6m |
| Takagi et al. (63) | Descriptive study | Cerebral arteriovenous malformation (Japan) | 1 | 2y | 25 mg IV | Detection and removal of residual nidus |
| Tanabe et al. (62) | Descriptive study (prospective) | Moyamoya disease (Japan) | 8/19 | Mean age for ped patients: 9.6 ± 3.1 y | 5 mg IV | 37% success for visualization of anterior branch of middle meningeal artery |
| Tsuzuki et al. (66) | Descriptive study | Endoscopic biopsy of intraventricular tumors (Japan) | 3 | 13–14y | 12.5 mg IV | Identification of tumor margins. Limitations: Unable to visualize the dissemination areas. |
| Ueba et al. (67) | Descriptive study | Spinal cord hemangioblastoma resection (Japan) | 1 | 19m | 5 mg IV | No recurrence at 1m |
| Pediatric cardiac surgery ( n = 5) | ||||||
| Kato et al. (40) | Descriptive study | Chylothorax post-coarctectomy (Japan) | 1 | 2y | SC injection in bilateral dorsalis pedis (dose unspecified) 1 | No recurrence at 6m |
| Kogon et al. (45) | Descriptive study (prospective) | Coronary artery re-implantations, coarctation repairs, palliative shunts, pulmonary artery reconstructions (United States) | 40 | 1.25 mg IV (<1y), 2.5 mg IV (<16y), 5 mg IV (adults) | 18/30 adequate images (60%), highest image adequacy for Blalock-Taussig shunts | |
| Pourmoghadam et al. (52) | Descriptive study | Redo congenital cardiac surgeries (United States) | 3/4 | 5 mg IV | Identification of aberrant coronary vascular anatomy, useful when preoperative imaging not available | |
| Tan et al. (61) | Descriptive study | Post-Norwood procedure chylothorax (United States) | 1 | 5w | 25 mcg intradermal in dorsum L foot, 12.5 mcg dorsum R foot, 12.5 mcg dorsum L hand | Limitations: failure to visualize leak, postoperative patient's death (not due to ICG). |
| Vogt et al. (68) | Descriptive study | Arterial switch operation (Germany) | 1 | 5d | 0.05 ml/kg IV | Visualization of anatomy and flow dynamics in coronary artery system |
| Pediatric plastic surgery ( n = 12) | ||||||
| Cheng et al. (17) | Experimental study (prospective) | Primary lymphedema (Taiwan) | 9 | Mean: 9.2y | 0.5%, 0.5 ml, SC 1st and 4th web spaces of dorsal aspect of bilateral limbs | Improves quality of life and reduces episodes of cellulitis |
| Drobot et al. (21) | Descriptive study | Axillary lymphatic malformation (Israel) | 1 | 14y | 0.75 mg SC, interdigits of ipsilateral hand | Successful intraoperative ICG lymphography to preserve normal lymphatic vessels |
| Greives et al. (30) | Descriptive study | Congenital arm and hand lymphedema (United States) | 1 | 21m | 12.5 μg intradermal, dorsum of each foot and hand | Guide treatments and evaluate lymphatic anatomy and contractile function |
| Hinchcliff et al. (33) | Descriptive study | Perfusion assessment of scalp closure (United States) | 1 | 12m | 2.5 mg IV | Useful to assess vascularization of flaps |
| Ishikawa et al. (38) | Experimental study (prospective) | Percutaneous sclerotherapy of soft-tissue venous malformations (Japan) | 13/15 | 3–64y | 0.01 mg/ml, direct injection in venous malformations | Observational depth <1 cm, additional monitor for percutaneous sclerotherapy of venous malformations Limitations: no fluorescence in 2 patients; no complication with ICG, but adjacent tissue ulceration (n = 1) |
| Kaneshi et al. (39) | Descriptive study | Lymphatic dysplasia (Japan) | 1 | 248d | Not specified | Early diagnosis and severity assessment of lymphatic dysplasia |
| Kato et al. (41) | Descriptive study | Peri-orbital lymphangioma (Japan) | 1 | 11m | 0.005 mg SC at multiple loci | Detection of exact location of lymph vessels with minimum skin incision |
| Kato et al. (42) | Analytic experimental study (prospective) | Lymphatic malformations (Japan) | 20 | 11m−10y | 0.0125 mg in multiple spots, distal to lymphatic malformation | Limitations: depth 1 cm |
| Martins et al. (46) | Analytic cohort study (retrospective) | Autologous ear reconstruction (United States) | 21 | 8.3y | 5 mg IV | Decreased number of surgical revisions in cases with ICG (p = 0.03) |
| Ogata et al. (50) | Descriptive study | Lymphedema (Japan) | 1/5 | 12y | 0.2 ml Diagnogreen 0.5%SC | Guides intraoperative skin incisions et lymphaticovenular anastomoses Limitations: depth 2 cm, limited area (10 x 10 cm) |
| Shirota et al. (57) | Descriptive study | Lymphatic malformations of abdominal wall (Japan) | 1 | 15y | 0.125 mg SC and intradermal in core and 2 marginal regions of tumor | Confirmation of the extent of the tumor, complete resection of tumor, no residual fluorescence. No recurrence. Limitations: border not clearly visualized (ICG spillage) |
| Tomioka et al. (65) | Descriptive study | Congenital syndactyly (Japan) | 1 | 1y | Not specified | Used for flap perfusion and after microanastomosis |
| Pediatric urology ( n = 3) | ||||||
| Esposito et al. (24) | Descriptive study (retrospective) | Laparoscopic Palomo varicocelectomy (Italy) | 25 | 2–16 y | 0.01 mg, left testicle | Clear detection of lymphatics in 100% patients after 20–30 s, maximum of 18 m of follow-up, no recurrence and no hydrocele |
| Esposito et al. (25) | Analytic experimental study (ambispective) | Laparoscopic or robotic urological procedures (varicocelectomy, nephrectomy, renal cyst deroofing) (Italy) | 57 | 1–18y | 0.3 mg/ml/kg, intra-testicular vs. IV depending on indication | Definition of surgical anatomy and vascularisation; no clear advantage in nephrectomy |
| Herz et al. (32) | Descriptive study | Pediatric robot-assisted laparoscopic heminephrectomy (United States) | 6 | 0.8–13 y | 1.25–2.5 mg IV | No extension of operative time |
| Pediatric orthopedics ( n = 3) | ||||||
| Aung et al. (11) | Descriptive study | Rotationplasty for sarcoma patients (Germany) | 3 | 20–132 m | 0.1 mg/kg IV | Intraoperative monitoring of limb and sciatic nerve perfusion, fluorescence seen after 20 s |
| Cleveland et al. (19) | Descriptive study | Trauma, circumferential open wound to posterior heel with exposed calcaneus (United States) | 1/4 | 15 y | Not specified | Perfusion assessment during debridement |
| Connolly et al. (20) | Descriptive study | Trauma, Salter-Harris 2 ankle fracture with neurovascular compromise after surgery (United States) | 1 | 13 y | 4 ml IV | Guides surgical therapy for excision of devitalized tissue, aids in decision-making for major considerations such as revascularization or amputation |
d, days; kg, kilograms; ICG, indocyanine green; IV, intravenous; m, months; mg, milligrams; ml, milliliters; SC, subcutaneous; lap, laparoscopic; FU, follow-up; y, years.
*
Only the last 15 cases were done under ICG-FA.
†
Only the last three patients were done under ICG-FA.
‡
One patient with diffuse strong fluorescence underwent liver transplant 6 months after Kasai.