USE OF FLUORESCENCE-GUIDED SURGERY IN CHILDHOOD

Abstract

Fluorescent-guided surgery using indocyanine green (ICG) is a rapidly expanding surgical technology, but its application in pediatrics remains unknown. Authors represent a descrip-tive analysis of the current applications of ICG in pediatric surgery based on a systematic bibliographical review on this topic. Material and methods used: the study searched articles in 3 major scientific databases (MEDLINE, PubMed and eLIBRARY.RU) published after 2000 for the keywords as follows: fluorescent-guided surgery, indocyanine green, ICG navigation, children. Two researchers independently reviewed the titles and abstracts of the primary search to avoid discrepancies. Results: initial database search yielded 762 titles. After the exclusion, 25 full-text publications were included in the generalization. Most studies were conducted in Italy (n=6) and the UK (n=6) followed in descending order by North America (n=5), Japan (n=4), Spain (n=2) and China (n=2). The distribution by time of publication was as follows: 2019 - 3, 2020 - 2; 2021 - 8; 2022 - 12. A systematic review includes 396 surgical interventions performed on pediatric patients using ICG. The most frequently performed surgical procedure in childhood was the Palomo varicocelectomy (66). This is followed by: abdominal tumors - 59, esophageal anastomosis - 53, renal cyst and duplication - 38, chest tumors - 37, ovarian tumors - 28, cholecystectomy - 26, kidney tumors - 24, liver tumors - 19, identification aortocoronary fistulas - 16. Most often, the drug was administered during the operation - 15 publications, 1 day before the operation - 9 publications, immediately be-fore the operation - a single publication. The methods of administration were distributed as follows: intravenous - 21, intraluminal - 2, intraorgan - 1, intratesticular - 1. Dosing of the drug depends on the method of application of ICG and the area of its application. Most of-ten, the drug was used intravenously in dosages from 0.1 to 0.75 mg/kg. For tumors, in-creased doses of the drug were used from 1.5 mg/kg for tumors of the abdominal cavity to 2 mg/kg for hyperinsulinism. Insufficient visualization of anatomical objects was only re-ported in 3 cases. Information about the side effects of the introduction of ICG in the body of a child is scarce and is represented by only 2 mentions of cardiac arrest and desaturation, which both ended safely. Conclusion: current trends demonstrate that fluorescent-guided surgery has become commercially available and is increasingly being used among pediatric surgeons to treat a wide range of diseases, including hepatobiliary surgery, oncology, urolo-gy, cardiac and vascular surgery, and is also used to assess blood flow in operated organs of a patient.