Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS

ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice

ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system

In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers

ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes

ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy

The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images

For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization

If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult

For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively

For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning

For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line

In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG

For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels

Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases

The spermatic bundle contains three to four lymphatic vessels

In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles

ICG vial remains usable for six hours after preparation

No adverse effects of ICG were observed in the presenter's experience

There is no maximum dose limit for ICG based on adult surgery studies