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Background <p>Indocyanine green (ICG) fluorescence imaging is increasingly incorporated into robotic liver resections (RLR), yet clinical practice regarding timing, dosage, and staining techniques is divergent. This international expert survey aimed to characterize current practices for ICG in RLR.</p> Methods <p>Experts in RLR were invited to participate based on surgical volume (experience of <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\ge\)</EquationSource> <EquationSource Format="MATHML"><math> <mo>≥</mo> </math></EquationSource> </InlineEquation> 50 RLR and <InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\ge\)</EquationSource> <EquationSource Format="MATHML"><math> <mo>≥</mo> </math></EquationSource> </InlineEquation> 30 annual RLR). A 74-item questionnaire was developed following a literature search and reviewed by a steering committee. The survey addressed indications, timing, dosage, imaging technology, benefits, limitations, training, and future directions of ICG use. Responses collected between September and October 2025 were analyzed.</p> Results <p>Seventy experts from 19 countries completed the survey, corresponding to an 88% response rate. Centers performed a median of 180 annual liver resections, including 55 RLR. Most experts used ICG (96%) during RLR. Anatomical demarcation (91%), tumor localization (60%), and biliary anatomy assessment (60%) were the most frequent indications. 60% of experts use preoperative ICG, while intraoperative ICG is mainly administered for demarcation (67%) and biliary tract visualization (40%). Considerable heterogeneity exists in dosage, timing, and staining techniques, particularly in cirrhotic livers and for tumor localization. 53% of the experts had standard operating procedures, whereas 64% expressed the need for a higher degree of standardization. Reported benefits of ICG use included improved anatomical orientation, margin assessment, lesion detection, and support during complex resections. Perceived limitations included background fluorescence, tissue penetration and variable staining in diseased parenchyma. 80% anticipated improved outcomes with combined ICG and three-dimensional image-guidance.</p> Conclusion <p>ICG fluorescence is widely used in RLR and is an important cornerstone for precision-guided robotic liver surgery. Standardized clinical practice guidelines, structured training, and technological improvements in imaging and navigation systems are claimed to optimize its clinical use.</p>

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Clinical practice of indocyanine green fluorescence imaging in robotic liver surgery – a global expert survey

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Noa L. E. Aegerter,
  • Christoph Kuemmerli,
  • Adrian T. Billeter,
  • Caroline Berchtold,
  • Felix Nickel,
  • Cristiano Guidetti,
  • Taiga Wakabayashi,
  • Iswanto Sucandy,
  • Brian K. Goh,
  • Mathieu D’Hondt,
  • Hugo Pinto Marques,
  • Janina Eden,
  • Philipp Dutkowski,
  • Jason Hawksworth,
  • Patrick Starlinger,
  • Beat P. Müller,
  • Philip C. Müller,
  • Yuta Abe,
  • Jawad Ahmad,
  • Adnan Alseidi,
  • Koij Asai,
  • Horacio Asbun,
  • Fabrizio Di Benedetto,
  • Ielpo Benedetto,
  • Emrullah Birgin,
  • Ugo Boggi,
  • Ruth Bustamante,
  • Tan To Cheung,
  • Hop Tran Cao,
  • Yee Lee Cheah,
  • Roland Croner,
  • Zoltan Czigany,
  • Nroiyuki Egawa,
  • Alessandro Ferrero,
  • David Fuks,
  • Daisuke Fukumori,
  • Stefan Gilg,
  • Jeroen Hagendoorn,
  • Shinya Hayami,
  • Asmus Heumann,
  • Takao Ide,
  • Taku Iida,
  • Osamu Itano,
  • Jan Philipp Jonas,
  • Yutaro Kato,
  • Felix Krenzien,
  • Philipp Kron,
  • Yoshikuni Kawaguchi,
  • Mickael Lesurtel,
  • Charles Chung-Wei Lin,
  • John B. Martinie,
  • Takuya Minagawa,
  • Zenichi Morise,
  • Yutaka Nakano,
  • Yusuke Nie,
  • Atsushi Oba,
  • Fabrizio Panaro,
  • Florian Primavesi,
  • Nuh Rahbari,
  • Francesca Ratti,
  • Christoph Reissfelder,
  • Ricardo Robles-Campos,
  • Andrea Ruzzenente,
  • Olivier Saint-Marc,
  • Moritz Schmelzle,
  • Daniel Seehofer,
  • Jimin Son,
  • Gregor Stavrou,
  • Stefan Stättner,
  • Benjamin Struecker,
  • Rutger-Jan Swijnenburg,
  • Yu Takahashi,
  • Samer Tohme,
  • Christian Toso,
  • Roberto Ivan Troisi,
  • Stéphanie Truant,
  • Christoph Tschuor,
  • Roeland F. de Wilde

摘要

Background

Indocyanine green (ICG) fluorescence imaging is increasingly incorporated into robotic liver resections (RLR), yet clinical practice regarding timing, dosage, and staining techniques is divergent. This international expert survey aimed to characterize current practices for ICG in RLR.

Methods

Experts in RLR were invited to participate based on surgical volume (experience of \(\ge\) ≥ 50 RLR and \(\ge\) ≥ 30 annual RLR). A 74-item questionnaire was developed following a literature search and reviewed by a steering committee. The survey addressed indications, timing, dosage, imaging technology, benefits, limitations, training, and future directions of ICG use. Responses collected between September and October 2025 were analyzed.

Results

Seventy experts from 19 countries completed the survey, corresponding to an 88% response rate. Centers performed a median of 180 annual liver resections, including 55 RLR. Most experts used ICG (96%) during RLR. Anatomical demarcation (91%), tumor localization (60%), and biliary anatomy assessment (60%) were the most frequent indications. 60% of experts use preoperative ICG, while intraoperative ICG is mainly administered for demarcation (67%) and biliary tract visualization (40%). Considerable heterogeneity exists in dosage, timing, and staining techniques, particularly in cirrhotic livers and for tumor localization. 53% of the experts had standard operating procedures, whereas 64% expressed the need for a higher degree of standardization. Reported benefits of ICG use included improved anatomical orientation, margin assessment, lesion detection, and support during complex resections. Perceived limitations included background fluorescence, tissue penetration and variable staining in diseased parenchyma. 80% anticipated improved outcomes with combined ICG and three-dimensional image-guidance.

Conclusion

ICG fluorescence is widely used in RLR and is an important cornerstone for precision-guided robotic liver surgery. Standardized clinical practice guidelines, structured training, and technological improvements in imaging and navigation systems are claimed to optimize its clinical use.