Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper
Abstract Background Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies,...
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2025-02-01
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| Series: | World Journal of Emergency Surgery |
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| Online Access: | https://doi.org/10.1186/s13017-025-00575-w |
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| author | Belinda De Simone Fikri M. Abu-Zidan Luigi Boni Ana Maria Gonzalez Castillo Elisa Cassinotti Francesco Corradi Francesco Di Maggio Hajra Ashraf Gian Luca Baiocchi Antonio Tarasconi Martina Bonafede Hung Truong Nicola De’Angelis Michele Diana Raul Coimbra Zsolt J. Balogh Elie Chouillard Federico Coccolini Micheal Denis Kelly Salomone Di Saverio Giovanna Di Meo Arda Isik Ari Leppäniemi Andrey Litvin Ernest E. Moore Alessandro Pasculli Massimo Sartelli Mauro Podda Mario Testini Imtiaz Wani Boris Sakakushev Vishal G. Shelat Dieter Weber Joseph M. Galante Luca Ansaloni Vanni Agnoletti Jean-Marc Regimbeau Gianluca Garulli Andrew L. Kirkpatrick Walter L. Biffl ICG-Fluorescence Guided Emergency Surgery Consensus Participants Fausto Catena |
| author_facet | Belinda De Simone Fikri M. Abu-Zidan Luigi Boni Ana Maria Gonzalez Castillo Elisa Cassinotti Francesco Corradi Francesco Di Maggio Hajra Ashraf Gian Luca Baiocchi Antonio Tarasconi Martina Bonafede Hung Truong Nicola De’Angelis Michele Diana Raul Coimbra Zsolt J. Balogh Elie Chouillard Federico Coccolini Micheal Denis Kelly Salomone Di Saverio Giovanna Di Meo Arda Isik Ari Leppäniemi Andrey Litvin Ernest E. Moore Alessandro Pasculli Massimo Sartelli Mauro Podda Mario Testini Imtiaz Wani Boris Sakakushev Vishal G. Shelat Dieter Weber Joseph M. Galante Luca Ansaloni Vanni Agnoletti Jean-Marc Regimbeau Gianluca Garulli Andrew L. Kirkpatrick Walter L. Biffl ICG-Fluorescence Guided Emergency Surgery Consensus Participants Fausto Catena |
| author_sort | Belinda De Simone |
| collection | DOAJ |
| description | Abstract Background Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. Aim This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. Methods Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. Results ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. Conclusions Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures. Graphical abstract |
| format | Article |
| id | doaj-art-911bba9fcff8480a954112f5cac0ebf8 |
| institution | OA Journals |
| issn | 1749-7922 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj-art-911bba9fcff8480a954112f5cac0ebf82025-08-20T02:13:14ZengBMCWorld Journal of Emergency Surgery1749-79222025-02-0120113510.1186/s13017-025-00575-wIndocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paperBelinda De Simone0Fikri M. Abu-Zidan1Luigi Boni2Ana Maria Gonzalez Castillo3Elisa Cassinotti4Francesco Corradi5Francesco Di Maggio6Hajra Ashraf7Gian Luca Baiocchi8Antonio Tarasconi9Martina Bonafede10Hung Truong11Nicola De’Angelis12Michele Diana13Raul Coimbra14Zsolt J. Balogh15Elie Chouillard16Federico Coccolini17Micheal Denis Kelly18Salomone Di Saverio19Giovanna Di Meo20Arda Isik21Ari Leppäniemi22Andrey Litvin23Ernest E. Moore24Alessandro Pasculli25Massimo Sartelli26Mauro Podda27Mario Testini28Imtiaz Wani29Boris Sakakushev30Vishal G. Shelat31Dieter Weber32Joseph M. Galante33Luca Ansaloni34Vanni Agnoletti35Jean-Marc Regimbeau36Gianluca Garulli37Andrew L. Kirkpatrick38Walter L. Biffl39ICG-Fluorescence Guided Emergency Surgery Consensus ParticipantsFausto Catena40Department of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL RomagnaDepartment of Surgery, College of Medicine and Health Sciences, United Arab Emirates UniversityDepartment of General and Minimally Invasive Surgery, Fondazione IRCCS – Ca’ Granda - Ospedale Maggiore Policlinico di MilanoEmergency Surgery Unit, Department of General Surgery, Pompeu Fabra University, Hospital del MarDepartment of General and Minimally Invasive Surgery, Fondazione IRCCS – Ca’ Granda - Ospedale Maggiore Policlinico di MilanoDepartment of Surgical, Medical andMolecularPathology and Critical Care Medicine, University of PisaUpper Gastro-Intestinal Surgery Unit, Department of General Surgery, Croydon University HospitalUpper Gastro-Intestinal Surgery Unit, Department of General Surgery, Croydon University HospitalUnit of General Surgery, Department of Clinical and Experimental Sciences, University of BresciaUOC General Surgery, ASST CremonaUOC General Surgery, ASST CremonaAcute Care and Minimally Invasive Surgery, Scripps Memorial Hospital - La Jolla, Green, and EncinitasUnit of Robotic and Minimally Invasive Digestive Surgery, Ferrara University HospitalDepartment of Surgery, University Hospital of GenevaRiverside University Health System Medical CenterDepartment of Traumatology, John Hunter Hospital and University of NewcastleGeneral Surgery Department, American Hospital of ParisDepartment of General Surgery, University Hospital of PisaMedAllianceGeneral Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli PicenoDepartment of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari “A. Moro”Istanbul Medeniyet UniversityDivision of Emergency Surgery, Helsinki University Hospital and University of HelsinkiDepartment of Surgical Diseases No. 3, Gomel State Medical University, University ClinicErnest E Moore Shock Trauma Center at Denver Health, University of ColoradoDepartment of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari “A. Moro”Department of General Surgery, Macerata HospitalDepartment of Surgical Science, Unit of Emergency Surgery, University of CagliariDepartment of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari “A. Moro”Department of Surgery, Government Gousia Hospital, DHSGeneral Surgery Department, Medical University, University Hospital St GeorgeDepartment of General Surgery, Tan Tock Seng HospitalDepartment of General Surgery, Royal Perth Hospital & The University of Western AustraliaUC Davis Health, Hospital Clinical Care Services, University of CaliforniaDepartment of General Surgery, University of PaviaLevel 1 Trauma Center, Bufalini Hospital, AUSL RomagnaService de Chirurgie Digestive du CHU d’Amiens, CHU Sud, Centre Hospitalier Universitaire Amiens-Picardie Site SudDepartment of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL RomagnaDepartments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical CentreDivision of Trauma/Acute Care Surgery, Scripps Clinic Medical GroupDepartment of General and Emergency Surgery, Bufalini Hospital‐Level 1 Trauma Center, AUSL RomagnaAbstract Background Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. Aim This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. Methods Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. Results ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. Conclusions Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures. Graphical abstracthttps://doi.org/10.1186/s13017-025-00575-wFluorescenceAngiographyCholangiographyEmergencySurgeryPrecision |
| spellingShingle | Belinda De Simone Fikri M. Abu-Zidan Luigi Boni Ana Maria Gonzalez Castillo Elisa Cassinotti Francesco Corradi Francesco Di Maggio Hajra Ashraf Gian Luca Baiocchi Antonio Tarasconi Martina Bonafede Hung Truong Nicola De’Angelis Michele Diana Raul Coimbra Zsolt J. Balogh Elie Chouillard Federico Coccolini Micheal Denis Kelly Salomone Di Saverio Giovanna Di Meo Arda Isik Ari Leppäniemi Andrey Litvin Ernest E. Moore Alessandro Pasculli Massimo Sartelli Mauro Podda Mario Testini Imtiaz Wani Boris Sakakushev Vishal G. Shelat Dieter Weber Joseph M. Galante Luca Ansaloni Vanni Agnoletti Jean-Marc Regimbeau Gianluca Garulli Andrew L. Kirkpatrick Walter L. Biffl ICG-Fluorescence Guided Emergency Surgery Consensus Participants Fausto Catena Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper World Journal of Emergency Surgery Fluorescence Angiography Cholangiography Emergency Surgery Precision |
| title | Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper |
| title_full | Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper |
| title_fullStr | Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper |
| title_full_unstemmed | Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper |
| title_short | Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper |
| title_sort | indocyanine green fluorescence guided surgery in the emergency setting the wses international consensus position paper |
| topic | Fluorescence Angiography Cholangiography Emergency Surgery Precision |
| url | https://doi.org/10.1186/s13017-025-00575-w |
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