Indocyanine Green Fluorescence Imaging in Hepatic Surgery

Indocyanine green fluorescence imaging has emerged as a powerful adjunct in hepatic surgery, offering real‐time visualisation of liver anatomy, tumour boundaries and biliary structures under near‐infrared light. After intravenous administration, the dye is taken up by hepatocytes and excreted into bile, creating distinct fluorescence patterns that distinguish healthy parenchyma from malignant lesions. This technique enhances the surgeon’s ability to achieve clear resection margins, detect superficially located or occult metastases and identify individual liver segments for precise anatomical hepatectomy. Its minimally invasive compatibility with laparoscopic and robotic platforms further supports safer, more efficient resections by reducing intraoperative blood loss and operative time. In addition to tumour mapping, fluorescence cholangiography delineates biliary anatomy, reducing the risk of ductal injury. Recent advances in dosing protocols and imaging hardware have optimised signal intensity and duration, while emerging applications integrate fluorescence guidance with other modalities such as ultrasonography and photoacoustic imaging. Overall, indocyanine green fluorescence imaging represents a global advance towards more accurate, reproducible and patient‐centred liver surgery.

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Indocyanine Green Fluorescence Imaging in Hepatic Surgery publication trend

The graph below shows the total number of articles in indocyanine green fluorescence imaging in hepatic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Indocyanine green (ICG): A water-soluble tricarbocyanine dye that fluoresces in the near-infrared spectrum and is cleared exclusively by the liver.

Near-infrared fluorescence imaging (NIRF): A technique that captures emitted light from fluorescent agents at wavelengths beyond visible red light to visualise structures in real time.

Hepatectomy: Surgical resection of part or all of the liver, often classified as anatomical or non-anatomical based on segmental boundaries.

R0 resection: Complete tumour removal with histologically negative margins, indicating no residual malignant cells at the cut surface.

Laparoscopic ultrasonography (LUS): Intraoperative ultrasound performed via laparoscopic instruments to image deep or subcapsular liver lesions beyond visual field.

References

1. Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance. Surgical Endoscopy (2016).
2. Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases. Surgery Today (2020).
3. Short- and Long-Term Outcomes of Indocyanine Green Fluorescence Navigation- Versus Conventional-Laparoscopic Hepatectomy for Hepatocellular Carcinoma: A Propensity Score-Matched, Retrospective, Cohort Study. Annals of Surgical Oncology (2023).
4. Photoacoustic Tomography of Human Hepatic Malignancies Using Intraoperative Indocyanine Green Fluorescence Imaging. PLOS ONE (2014).
5. Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany. Innovative Surgical Sciences (2021).