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Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)—WSES project

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Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.

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ICG fluorescence-guided emergency surgery survey consortium: Luigi Boni, Gian Luca Baiocchi, Elisa Cassinotti, Michele Diana, Ana Maria Gonzalez Castillo, Francesco Di Maggio, Antonio Tarasconi, Hung Truong, Adam Peckham-Cooper, Aishath Azna Ali, Aitor Landaluce-Olavarria, Alan Biloslavo, Alberto Sartori, Aleix Martínez-Pérez, Aleksandar Karamarkovic, Alessandra Marano, Alessandro Bergna, Alessio Giordano,, Alexander Julianov, Alexandros Chamzin, ALEXANDROS CHAMZIN, Alexis Theodorou, Alfie J Kavalakat, Amedeo Antonelli, Amit Gupta, Ana-Maria Musina, Andee Dzulkarnaen Zakaria, Andrea Balla, Andrea Barberis, Andrea Cavallaro, Andrew Gumbs, Andrey Litvin, Antonio Pesce, ARDA ISIK, Aristeidis Papadopoulos, Asyraf Bin Mohd Zuki, Barbara Petronio, Beatrice Torre, Biagio Picardi, Boyko Atanasov, Charalampos Seretis, Chiara Fantozzi, Christos Chouliaras, Christos Doudakmanis, Claudia Zaghi, Damien Massalou, Daniele Delogu, Daniele Morezzi, Danilo Vinci, Daunia Verdi, Davide Luppi, Davide Papis, de'Angelis Nicola, Desire Pantalone, Diego Coletta, Diego Visconti, Diletta Corallino, Dimitrios Oikonomou, DIMITRIOS SCHIZAS, Dionysios Prevezanos, Dmitry Adamovich, Edoardo Baldini, Eftychios Lostoridis, Elena-Adelina Toma, Elisa Reitano, Enrico Pinotti, Ernest E Moore, Evgeni Dimitrov, Fabio Marino, Fabrizio D'Acapito, Fausto Rosa, Felipe Pareja-Ciuro, Filipe Ramalho de Almeida, Firdaus Hayati, Flavio Milana, Francesca Pecchini, Francesco Pata, Francesk Mulita, Gabriela Arroyo Murillo, Gennaro Martines, Gennaro Perrone, Georgios Ioannis Verras, GEORGIOS ZACHARIS, Gianluca Pellino, Gianluca Vanni, Gianmaria Casoni Pattacini, Giorgio Giraudo, Giuseppe Brisinda, Giuseppe Curro, Giuseppe Evola, Giuseppe Palomba, Goran Augustin, Guglielmo Niccolò Piozzi, Gustavo Miguel Machain, Hazim Eltyeb, Heba Taher, Huseyin Kemal Rasa, Ibrahim Umar Garzali, Igor A. Kryvoruchko, Imtiaz Wani, Isidoro DI CARLO, Jacopo Andreuccetti, Jin Jiun Mah, Juan Carlos Salamea, Justin Davies, Kenneth Y. Y. Kok, Konstantinos Perivoliotis, Lali Patsia, Larysa Sydorchuk, Leandro Siragusa, Lorenzo Petagna, Lovenish Bains, Luca Ferrario, Luigi Eduardo Conte, Luis Tallon-Aguilar, Lukas Werner Widmer, Maciej, Mahir Gachabayov, Marco Clementi, Marco Materazzo, Marco Pellicciaro, Maria Papadoliopoulou, Marianna Capuano, Mario Giuffrida, Mario Serradilla-Martín, Massimiliano Veroux, Massimo Chiarugi, Matteo Santoliquido, Mauro Podda, Maximilian Scheiterle, Mercedes Estaire-Gómez, Micaela Piccoli, Michele Ammendola, Mihail Slavchev, Mika Ukkonen, Mirko Barone, Mohamed Arif & Hameed Sulta, Monica Ortenzi, Monika Gureh, Nicola Cillara, Nikolaos Michalopoulos, Nikolaos Pararas, Octavian Enciu, Orestis Ioannidis, Pasquale Cianci, Pierpaolo Sileri, Pierpaolo Sileri, Pietro Fransvea, Piotr Major, Ruslan Sydorchuk, Sara Ingallinella, Selmy S Awad, Semra Demirli Atici, Sentilnathan Subramaniam, Serge Chooklin, Serhat Meric, Sharfuddin Chowdhury, Simone Gargarella, Sofia Xenaki, Stefano Olmi, Stefano Rossi, Theodoros Sidiropoulos, Timothy Craig Hardcastle, Valentin Calu, Vasilescu Alin Mihai, Victor Lopez-Lopez, Vincenza Paola Dinuzzi, Vincenzo Trapani, Vishal Shelat, Zaza Demetrashvili.


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Authors and Affiliations




BDS conceived, designed the study, wrote the questionnaire, collected and analysed data, revised the literature and wrote the manuscript. FC and FAZ critically revised the draft. BDS revised the manuscript according to comments and suggestions. SS revised last articles published about ICG and emergency surgery. GD revised the English written. All the authors read and approved the manuscript. The ICG consortium answered to the questionnaire.

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Correspondence to Belinda De Simone.

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Belinda De Simone has no conflict of interest to declare. Fikri M Abu Zidan has no conflict of interest to declare. Sara Saeidi has no conflict of interest to declare. Genevieve Deeken has no conflict of interest to declare. Massimo Sartelli has no conflict of interest to declare. Walter Biffl has no conflict of interest to declare. Ernest E Moore has no conflict of interest to declare. Federico Coccolini has no conflict of interest to declare. Salomone Di Saverio has no conflict of interest to declare. Luca Ansaloni has no conflict of interest to declare. Fausto Catena has no conflict of interest to declare.

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The members of the ICG Fluorescence Guided Emergency Surgery Survey Consortium are listed in Acknowledgements.

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De Simone, B., Abu-Zidan, F.M., Saeidi, S. et al. Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)—WSES project. Updates Surg (2024).

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