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Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument

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A Correction to this article was published on 12 February 2024

A Correction to this article was published on 12 December 2023

This article has been updated

Abstract

Background

Indocyanine green (ICG) is an injectable fluorochrome that has recently gained popularity as a means of assisting intraoperative visualization during laparoscopic and robotic surgery. Many systematic reviews and meta-analyses have been published. We conducted a meta-review to synthesize the findings of these studies.

Methods

PubMed and Embase were searched to identify systematic reviews and meta-analyses coping with the uses of ICG in abdominal operations, including Metabolic Bariatric Surgery, Cholecystectomy, Colorectal, Esophageal, Gastric, Hepato-Pancreato-Biliary, Obstetrics and Gynecology (OG), Pediatric Surgery, Surgical Oncology, Urology, (abdominal) Vascular Surgery, Adrenal and Splenic Surgery, and Interdisciplinary tasks, until September 2023. We submitted the retrieved meta-analyses to qualitative analysis based on the AMSTAR 2 instrument.

Results

We identified 116 studies, 41 systematic reviews (SRs) and 75 meta-analyses (MAs), spanning 2013–2023. The most thoroughly investigated (sub)specialties were Colorectal (6 SRs, 25 MAs), OG (9 SRs, 15 MAs), and HPB (4 SRs, 12 MAs). Interestingly, there was high heterogeneity regarding the administered ICG doses, routes, and timing. The use of ICG offered a clear benefit regarding anastomotic leak prevention, particularly after colorectal and esophageal surgery. There was no clear benefit regarding sentinel node detection after OG. According to the AMSTAR 2 tool, most meta-analyses ranked as “critically low” (34.7%) or “low” (58.7%) quality. There were only five meta-analyses (6.7%) that qualified as “moderate” quality, whereas there were no “high” quality reviews.

Conclusions

Regardless of the abundance of pertinent literature and reviews, surgeons should be cautious when interpreting their results on ICG use in abdominal surgery. Future reviews should focus on ensuring methodological vigor; establishing clear protocols of ICG dose, route of administration, and timing; and improving reporting quality. Other sources of data (e.g., registries) and novel methods of data analysis (e.g., machine learning) might also contribute to an enhanced role of ICG as a decision-making tool in surgery.

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Authors and Affiliations

  1. Mohak Bariatric and Robotic Surgery Center, Sri Aurobindo Medical College Campus, Indore-Ujjain Highway Near MR-10 Crossing, Indore, Madhya Pradesh, 453555, India

    Athanasios G. Pantelis

  2. Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece

    Nikolaos Machairiotis, Sofoklis Stavros & Petros Drakakis

  3. Endometriosis Centre, London North West University Healthcare NHS Trust, Harrow, UK

    Nikolaos Machairiotis & Stewart Disu

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Supplementary Figure 1A. Distribution of the included studies by year of publication

Supplementary Figure 1B. Geographical distribution of the included studies

464_2023_10546_MOESM3_ESM.tif

Supplementary Figure 2. Distribution of the included systematic reviews (SR) and meta-analyses (MA) by scientific discipline / (sub)specialty

464_2023_10546_MOESM4_ESM.tif

Supplementary Figure 3. Distribution of the included meta-analyses by (sub)specialty and by overall quality score according to the AMSTAR 2 instrument

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Pantelis, A.G., Machairiotis, N., Stavros, S. et al. Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument. Surg Endosc 38, 511–528 (2024). https://doi.org/10.1007/s00464-023-10546-4

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