Indocyanine Green (ICG) binds to albumin and is metabolized by the liver. It absorbs near-infrared light and emits fluorescence, making it valuable in high-definition imaging systems. In upper gastrointestinal surgery, ICG is primarily used for tissue perfusion assessment (angiography), anatomical visualization, tumor localization, and lymph node mapping (lymphography).
A promising advancement in fluorescence-guided surgery involves using different wavelengths to enhance imaging. The Near Infrared II range (1,000–1,700 nm) improves tissue penetration, reduces noise, and produces sharper images, as demonstrated in preclinical studies. Additionally, molecular imaging probes beyond ICG are being explored for surgical guidance, cancer staging, and recurrence detection. However, target markers remain limited in upper GI surgery, and new probes lack the established safety profile of ICG.
Beyond fluorescence imaging, augmented reality (AR) and artificial intelligence (AI) are transforming surgical navigation and training. AI systems can recognize anatomical structures and surgical steps, aiding novice surgeons and paving the way for automated procedures in select scenarios.
In conclusion, fluorescence-guided surgery and AI/AR-assisted navigation represent exciting frontiers with vast potential for innovation in surgical precision and outcomes.
