De Simone Belinda, Abu-Zidan Fikri M, Boni Luigi, Castillo Ana Maria Gonzalez, Cassinotti Elisa, Corradi Francesco, Di Maggio Francesco, Ashraf Hajra, Baiocchi Gian Luca, Tarasconi Antonio, Bonafede Martina, Truong Hung, De'Angelis Nicola, Diana Michele, Coimbra Raul, Balogh Zsolt J, Chouillard Elie, Coccolini Federico, Kelly Micheal Denis, Di Saverio Salomone, Di Meo Giovanna, Isik Arda, Leppäniemi Ari, Litvin Andrey, Moore Ernest E, Pasculli Alessandro, Sartelli Massimo, Podda Mauro, Testini Mario, Wani Imtiaz, Sakakushev Boris, Shelat Vishal G, Weber Dieter, Galante Joseph M, Ansaloni Luca, Agnoletti Vanni, Regimbeau Jean-Marc, Garulli Gianluca, Kirkpatrick Andrew L, Biffl Walter L, Catena Fausto
Department of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy.
World J Emerg Surg. 2025 Feb 13;20(1):13. doi: 10.1186/s13017-025-00575-w.
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.
This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings.
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.
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.
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.
急诊环境下的决策本质上很复杂，要求外科医生迅速评估各种临床、诊断和环境因素。主要目标是在权衡诊断、管理策略和可用资源的同时，评估患者出现不良后果的风险。最近，吲哚菁绿（ICG）荧光成像已成为增强手术视野的一种有价值的工具，在择期手术中已证明其益处。
本共识文件为在急诊环境中标准化使用ICG荧光成像提供基于证据和专家意见的建议。
使用PICO框架，共识协调员确定了关于在急诊中实施ICG荧光引导手术的关键研究领域、主题和问题。进行了系统的文献综述，并使用GRADE标准评估证据。一组专家外科医生通过德尔菲共识过程对声明和建议进行了审查和完善，最终获得批准。
ICG荧光成像，包括血管造影和胆管造影，可改善急诊手术中的术中决策，有可能缩短手术时间、减少并发症和缩短住院时间。由于组织穿透有限（5 - 10毫米）以及在有明显炎症、瘢痕或肥胖的患者中性能可变，因此最佳使用需要仔细考虑剂量和时机。已知对碘或碘基造影剂过敏的患者禁用ICG。成功实施取决于适当的培训、设备可用性和仔细的患者选择。
在急诊手术中应优先采用先进技术和术中导航技术，如ICG荧光引导手术，以改善手术效果。该技术通过加强微创方法并提供对肠活力和胆道结构（传统上依赖外科医生视觉评估的区域）的卓越实时评估，体现了精准手术。在急诊环境中采用该技术需要适当的培训、设备可用性和标准化方案。需要进一步研究以评估成本效益并扩大其在紧急外科手术中的应用。
