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

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.

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.

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.

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. Graphical abstract Similar content being viewed by others Change history 12 February 2024 A Correction to this paper has been published: https://doi.org/10.1007/s00464-024-10744-8 12 December 2023 A Correction to this paper has been published: https://doi.org/10.1007/s00464-023-10646-1

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None. Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures Athanasios G. Pantelis, Nikolaos Machairiotis, Sofoklis Stavros, Stewart Disu, and Petros Drakakis has no conflicts of interest or financial ties to disclose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Figure 1A. Distribution of the included studies by year of publication (download TIF ) 464_2023_10546_MOESM3_ESM.tif (download 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 (download TIF ) Supplementary Figure 3. Distribution of the included meta-analyses by (sub)specialty and by overall quality score according to the AMSTAR 2 instrument Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article 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 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00464-023-10546-4