Indocyanine green (ICG)-GUIDED lymphatic sparing laparoscopic varicocelectomy in children and adolescents. Is intratesticular injection of the dye safe? A mid-term follow-up study

A Green Lantern for the Surgeon: A Review on the Use of Indocyanine Green (ICG) in Minimally Invasive Surgery

Indocyanine green (ICG) fluorescence imaging has revolutionized surgical practice across various medical and surgical specialties. This article reviews the clinical applications of ICG in abdominal, urological, thoracic, and gynecological surgery. ICG fluorescence imaging has been widely adopted in general surgery for various applications, including perfusion assessment, intraoperative visualization of the ureter, and tumor localization. It is particularly valuable in evaluating anastomotic leaks and aiding in precise tumor resection during minimally invasive surgeries. Studies have shown mixed results on its effectiveness in reducing anastomotic leak rates, highlighting the need for further research. In thoracic surgery, ICG facilitates the identification and resection of pulmonary bullae, as well as the precise localization of pulmonary nodules during video-assisted surgery. In urology, ICG aids in localizing renal tumors and guiding selective arterial occlusion during partial nephrectomy. Its role in identifying the lymphatic pathway in prostate cancer and sentinel lymph node biopsy in gynecological cancer is also discussed. Despite its benefits, the use of ICG fluorescence faces challenges such as limited tissue penetration, the potential for false results, a lack of standardized protocols, and high equipment costs. Nonetheless, it remains a powerful tool that could improve surgical outcomes.

Para-testicular injection of indocyanine green for laparoscopic immunofluorescence-guided lymphatic-sparing Palomo procedure: Promising preliminary results

Lymphatic-sparing Palomo procedure with intra-testicular injection of indocyanine green (ICG) has shown good results but the injection might harm the testes. This article describes the results of twelve consecutive patients where visualization and sparing were carried out successfully with para-testicular injection of ICG. Procedural details are reported thoroughly. Early experience shows convincing results, we believe that para-testicular injection leads to equally good visualization of testicular lymphatic vessels without the risk of testicular lesions. We will continue to use para-testicular injection and encourage others to do so to increase the amount of available data, allowing for evidence-based result in the future.