Indocyanine Green Fluorescence-Guided Surgery in Pediatric Hepatobiliary Procedures: A Feasibility Study for Improved Intraoperative Visualization

Introduction Indocyanine Green (ICG) fluorescence guided surgery (FGS) is reported extensively in adult operations, but its safety and applications in Pediatric populations remain to be comprehensively understood. The dose, administration protocols and intraoperative imaging benefits in Pediatric hepatobiliary operations are not clear. Objectives To identify the feasibility and applications of ICG Fluorescence Guided Surgery (FGS) in hepatobiliary surgeries (for biliary atresia, choledochal cyst, and cholelithiasis) in children. Methods This is a prospective observational study conducted from January 2021 to December 2022. A standard ICG dose of 0.5 mg/Kg/dose was administered intravenously to children undergoing operations for biliary atresia (18-24 hrs), choledochal cyst (12-18 hrs) and cholelithiasis (2-6 hrs) before the operation. Intraoperative imaging features and adverse events were recorded. Results ICG FGS was performed in seventeen patients. In biliary atresia (n = 9), liver fluorescence varied in each case, gallbladder didn’t show fluorescence, and there was increasing fluorescence as we reached the right depth during excision of fibrous biliary remnants. In choledochal cyst (n = 6) operations, and cholecystectomy (n = 2), real time imaging provided anatomical details of biliary tree and helped in safe dissection. No ICG-related adverse events occurred. Conclusion Indocyanine Green (ICG) fluorescence-guided surgery appears safe, feasible and beneficial in Pediatric hepatobiliary surgeries. For conditions like biliary atresia, choledochal cysts, and cholecystectomy, ICG facilitates safer surgical navigation and may reduce intraoperative complications. Future studies with standardized protocols and quantitative fluorescence assessment are needed to further refine its use and confirm its impact on surgical outcomes. Keywords: Indocyanine green, fluorescence-guided surgery, Pediatric, Hepatobiliary surgery