TY - JOUR
T1 - Clinical practice of indocyanine green fluorescence imaging in robotic liver surgery
T2 - a global expert survey
AU - Aegerter, Noa L.E.
AU - Kuemmerli, Christoph
AU - Robotic Liver Surgery Expert Group
AU - Billeter, Adrian T.
AU - Berchtold, Caroline
AU - Nickel, Felix
AU - Guidetti, Cristiano
AU - Wakabayashi, Taiga
AU - Sucandy, Iswanto
AU - Goh, Brian K.
AU - D’Hondt, Mathieu
AU - Marques, Hugo Pinto
AU - Eden, Janina
AU - Dutkowski, Philipp
AU - Hawksworth, Jason
AU - Starlinger, Patrick
AU - Müller, Beat P.
AU - Müller, Philip C.
AU - de Wilde, Roeland F.
AU - Tschuor, Christoph
AU - Truant, Stéphanie
AU - Troisi, Roberto Ivan
AU - Toso, Christian
AU - Tohme, Samer
AU - Takahashi, Yu
AU - Swijnenburg, Rutger Jan
AU - Struecker, Benjamin
AU - Stättner, Stefan
AU - Stavrou, Gregor
AU - Son, Jimin
AU - Seehofer, Daniel
AU - Schmelzle, Moritz
AU - Saint-Marc, Olivier
AU - Ruzzenente, Andrea
AU - Robles-Campos, Ricardo
AU - Reissfelder, Christoph
AU - Ratti, Francesca
AU - Rahbari, Nuh
AU - Primavesi, Florian
AU - Panaro, Fabrizio
AU - Oba, Atsushi
AU - Nie, Yusuke
AU - Nakano, Yutaka
AU - Morise, Zenichi
AU - Minagawa, Takuya
AU - Martinie, John B.
AU - Lin, Charles Chung Wei
AU - Lesurtel, Mickael
AU - Kawaguchi, Yoshikuni
AU - Kron, Philipp
AU - Hagendoorn, Jeroen
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.
PY - 2026/2/9
Y1 - 2026/2/9
N2 - Background: Indocyanine green (ICG) fluorescence imaging is increasingly incorporated into robotic liver resections (RLR), yet clinical practice regarding timing, dosage, and staining techniques is divergent. This international expert survey aimed to characterize current practices for ICG in RLR. Methods: Experts in RLR were invited to participate based on surgical volume (experience of ≥ 50 RLR and ≥ 30 annual RLR). A 74-item questionnaire was developed following a literature search and reviewed by a steering committee. The survey addressed indications, timing, dosage, imaging technology, benefits, limitations, training, and future directions of ICG use. Responses collected between September and October 2025 were analyzed. Results: Seventy experts from 19 countries completed the survey, corresponding to an 88% response rate. Centers performed a median of 180 annual liver resections, including 55 RLR. Most experts used ICG (96%) during RLR. Anatomical demarcation (91%), tumor localization (60%), and biliary anatomy assessment (60%) were the most frequent indications. 60% of experts use preoperative ICG, while intraoperative ICG is mainly administered for demarcation (67%) and biliary tract visualization (40%). Considerable heterogeneity exists in dosage, timing, and staining techniques, particularly in cirrhotic livers and for tumor localization. 53% of the experts had standard operating procedures, whereas 64% expressed the need for a higher degree of standardization. Reported benefits of ICG use included improved anatomical orientation, margin assessment, lesion detection, and support during complex resections. Perceived limitations included background fluorescence, tissue penetration and variable staining in diseased parenchyma. 80% anticipated improved outcomes with combined ICG and three-dimensional image-guidance. bICG fluorescence is widely used in RLR and is an important cornerstone for precision-guided robotic liver surgery. Standardized clinical practice guidelines, structured training, and technological improvements in imaging and navigation systems are claimed to optimize its clinical use.
AB - Background: Indocyanine green (ICG) fluorescence imaging is increasingly incorporated into robotic liver resections (RLR), yet clinical practice regarding timing, dosage, and staining techniques is divergent. This international expert survey aimed to characterize current practices for ICG in RLR. Methods: Experts in RLR were invited to participate based on surgical volume (experience of ≥ 50 RLR and ≥ 30 annual RLR). A 74-item questionnaire was developed following a literature search and reviewed by a steering committee. The survey addressed indications, timing, dosage, imaging technology, benefits, limitations, training, and future directions of ICG use. Responses collected between September and October 2025 were analyzed. Results: Seventy experts from 19 countries completed the survey, corresponding to an 88% response rate. Centers performed a median of 180 annual liver resections, including 55 RLR. Most experts used ICG (96%) during RLR. Anatomical demarcation (91%), tumor localization (60%), and biliary anatomy assessment (60%) were the most frequent indications. 60% of experts use preoperative ICG, while intraoperative ICG is mainly administered for demarcation (67%) and biliary tract visualization (40%). Considerable heterogeneity exists in dosage, timing, and staining techniques, particularly in cirrhotic livers and for tumor localization. 53% of the experts had standard operating procedures, whereas 64% expressed the need for a higher degree of standardization. Reported benefits of ICG use included improved anatomical orientation, margin assessment, lesion detection, and support during complex resections. Perceived limitations included background fluorescence, tissue penetration and variable staining in diseased parenchyma. 80% anticipated improved outcomes with combined ICG and three-dimensional image-guidance. bICG fluorescence is widely used in RLR and is an important cornerstone for precision-guided robotic liver surgery. Standardized clinical practice guidelines, structured training, and technological improvements in imaging and navigation systems are claimed to optimize its clinical use.
UR - https://www.scopus.com/pages/publications/105029821896
U2 - 10.1007/s00464-025-12553-z
DO - 10.1007/s00464-025-12553-z
M3 - Article
C2 - 41663748
AN - SCOPUS:105029821896
SN - 0930-2794
JO - Surgical Endoscopy
JF - Surgical Endoscopy
ER -