Use of Indocyanine Green Fluorescence Imaging in Thoracic and Esophageal Surgery

Calvin Sze Hang Ng*, Boon Hean Ong, Yin Kai Chao, Gavin M. Wright, Yasuo Sekine, Ian Wong, Zhexue Hao, Guangjian Zhang, Harit Chaturvedi, Subramanyeshwar Rao Thammineedi, Simon Law, Hyun Koo Kim

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Background: Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, to stage disease, and to reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophageal surgery, an expert panel sought to establish a set of recommendations at a consensus meeting. Methods: The panel included 12 experts in thoracic and upper gastrointestinal surgery from Asia-Pacific countries. Before meeting, 7 focus areas were defined: intersegmental plane identification for sublobar resections; pulmonary nodule localization; lung tumor detection; bullous lesion detection; lymphatic mapping of lung tumors; evaluation of gastric conduit perfusion; and lymphatic mapping in esophageal surgical procedures. A literature search of the PubMed database was conducted using keywords indocyanine green, fluorescence, thoracic, surgery, and esophagectomy. At the meeting, panelists addressed each focus area by discussing the most relevant evidence and their clinical experiences. Consensus statements were derived from the proceedings, followed by further discussions, revisions, finalization, and unanimous agreement. Each statement was assigned a level of evidence and a grade of recommendation. Results: A total of 9 consensus recommendations were established. Identification of the intersegmental plane for sublobar resections, localization of pulmonary nodules, lymphatic mapping in lung tumors, and assessment of gastric conduit perfusion were applications of fluorescence imaging that have the most robust current evidence. Conclusions: Based on best available evidence and expert opinions, these consensus recommendations may facilitate thoracic and esophageal surgery using fluorescence imaging.

Original languageEnglish
Pages (from-to)1068-1076
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number4
StatePublished - 04 2023

Bibliographical note

Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.


  • Humans
  • Indocyanine Green
  • Lung Neoplasms/surgery
  • Stomach/surgery
  • Lung/pathology
  • Optical Imaging/methods


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