Indocyanine green (ICG) fluorescence imaging is emerging as a game-changer in pancreatic surgery, enabling safe and effective intraoperative localisation of small pancreatic neuroendocrine tumours (pNETs).
In a study of five patients undergoing fluorescence-guided laparoscopic resection, this innovative technique proved its potential to revolutionise minimally invasive surgery.
The approach offers surgeons a precise and efficient way to detect and remove these hard-to-find tumours, setting a new standard in surgical care.
Pancreatic neuroendocrine tumours are rare but increasingly diagnosed due to advancements in imaging and routine health screenings.
Small tumours, often less than 2cm in diameter, pose a significant challenge during surgery due to their size and the lack of tactile feedback in laparoscopic procedures.
Traditionally, surgeons have relied on laparoscopic ultrasound for tumour localisation, but this method has notable limitations, including variability in accuracy and the need for specialised training.
The introduction of ICG fluorescence imaging represents a transformative solution. By injecting a precise dose of ICG dye into a peripheral vein during surgery, surgeons can visualise the tumour’s location and boundaries in real time under fluorescence laparoscopy.
This technique simplifies localisation and provides continuous guidance for resection, reducing the risk of incomplete tumour removal and improving surgical outcomes.
The study evaluated five female patients, aged 53 to 83, all diagnosed preoperatively with small pancreatic tumours.
Following ICG injection, all tumours were successfully visualised, allowing for precise laparoscopic resection. Importantly, all patients experienced uneventful recoveries, with only minor biochemical fistulae reported postoperatively.
Routine pathology confirmed negative surgical margins, with four patients diagnosed with stage G1 neuroendocrine tumours and one with endocrine cell hyperplasia, a potential precursor to tumour development.
The results underscore the safety and efficacy of ICG fluorescence imaging as a complementary tool to laparoscopic ultrasound. Unlike ultrasound, which requires significant expertise and preoperative positioning, ICG imaging is straightforward. It minimises the need for additional procedures, such as endoscopic ultrasound-guided dye injection or metallic marker placement.
This study has profound implications for surgeons worldwide. As laparoscopic surgery increasingly replaces traditional open procedures, the demand for reliable tumour localisation techniques has grown.
ICG fluorescence imaging offers several key advantages:
• Tumour visualisation occurs within minutes of the ICG injection, eliminating the unpredictability of ultrasound-based searches.
• Continuous fluorescence guidance allows for complete tumour resection and more accurate determination of surgical margins.
• The technique avoids preoperative punctures or invasive localisation methods, lowering patient risk and simplifying workflows.
In countries with limited access to advanced ultrasound equipment or expertise, ICG imaging could democratise high-precision pancreatic surgery.
Its relative ease of use and reproducibility make it an attractive option for specialised centres and general surgical settings.
While the study confirms the promise of ICG fluorescence imaging, standardising the injection dose and timing remains a priority for broader clinical adoption.
Ongoing research also explores its application in other pancreatic and abdominal tumours.
