背景:吲哚菁绿(ICG)是一种可注射的荧光染料,最近作为腹腔镜和机器人手术过程中辅助术中可视化的一种手段而受到欢迎。已经发表了许多系统评价和荟萃分析。我们进行了一项荟萃综述,以综合这些研究的结果。
方法:搜索PubMed和Embase以确定应对ICG在腹部手术中使用的系统评价和荟萃分析,包括代谢减肥手术,胆囊切除术,结肠直肠,食道,胃,肝-胰腺-胆道,妇产科(OG),儿科手术,肿瘤外科,泌尿外科,(腹部)血管外科,肾上腺和脾手术,和跨学科任务,直到2023年9月。我们将检索到的荟萃分析提交给基于AMSTAR2仪器的定性分析。
结果:我们确定了116项研究,41项系统评价(SRs)和75项荟萃分析(MA),跨越2013-2023年。调查最彻底的(亚)专科是结直肠(6个SRs,25MA),OG(9SR,15MA),和HPB(4个SRs,12MA)。有趣的是,关于施用的ICG剂量有很高的异质性,路线,和时间。ICG的使用在预防吻合口漏方面提供了明显的好处。尤其是在结肠直肠和食道手术后。OG后前哨淋巴结检测没有明显的好处。根据AMSTAR2工具,大多数荟萃分析的排名为“极低”(34.7%)或“低”(58.7%)质量。只有五项荟萃分析(6.7%)符合“中等”质量,而没有“高质量”的评论。
结论:无论相关文献和综述如何丰富,外科医生在解释他们在腹部手术中使用ICG的结果时应谨慎。未来的审查应侧重于确保方法学活力;建立明确的ICG剂量方案,给药途径,和时间安排;提高报告质量。其他数据源(例如,注册表)和新的数据分析方法(例如,机器学习)也可能有助于增强ICG作为外科手术决策工具的作用。
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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.