背景:近年来,吲哚菁绿(ICG)荧光引导手术在开腹和腹腔镜手术中的应用在各种临床环境中呈指数级扩展.欧洲内窥镜外科协会(EAES)就此主题发起了共识发展会议,旨在为外科界创建基于证据的声明和建议。
方法:选择了一个由外科医生组成的专家小组,并邀请他们参与这个项目。PubMed的系统评价,进行Embase和Cochrane文库以确定ICG荧光引导手术对临床实践和患者预后的潜在益处的证据。陈述和建议已准备好,并得到小组的一致同意;然后通过两轮在线调查将其提交给所有EAES成员,并在EAES年度大会上提交结果,巴塞罗那,2021年11月。
结果:共筛选18,273篇摘要,共纳入117篇。产生并批准了22项声明和16项建议。在某些地区,例如在腹腔镜胆囊切除术中使用ICG荧光引导手术,结直肠手术的灌注评估和妇科恶性肿瘤前哨淋巴结的搜索,文献中的大量证据使我们能够强烈建议使用ICG来获得更好的解剖学定义并减少术后并发症.
结论:总体而言,从专家小组进行的系统文献综述和扩展到所有EAES成员的调查来看,ICG荧光引导手术可以被认为是一种安全有效的技术。未来需要强大的临床研究来具体验证多个器官特异性应用以及该技术对临床结果的潜在益处。
In recent years, the use of Indocyanine Green (
ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a
consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community.
An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of
ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021.
A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of
ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications.
Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members,
ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.