Clinical Consensus Statement on the Use of Indocyanine Green Fluorescence-guided Surgery in Pediatric Patients

Title: Clinical Consensus Statement on the Use of Indocyanine Green Fluorescence-guided Surgery in Pediatric Patients 1. J Pediatr Surg. 2024 Nov;59(11):161657. doi: 10.1016/j.jpedsurg.2024.07.042. Epub 2024 Jul 30. Clinical Consensus Statement on the Use of Indocyanine Green Fluorescence-guided Surgery in Pediatric Patients. Szavay PO(1), Bondoc A(2), Esposito C(3), Goldstein SD(4), Harms M(5), Kowalewski G(6), Lautz TB(4), Lopez M(7), Pachl M(8), Pandya S(9), Piché N(10), Rothenberg SS(11), Ruiterkamp J(12), Scholz S(13), Zendejas B(14), Rentea RM(15). Author information: (1)Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland. (2)Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. (3)Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy. (4)Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. (5)Stryker Endoscopy, Stryker Nederland BV, Amsterdam, CM 1101, Netherlands. (6)Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, 04-730 Warsaw, Poland. (7)Division of Pediatric Surgery, Val d'Hebron Maternity and Children's Hospital, Barcelona, Spain. (8)Department of Paediatric Surgery and Urology, Birmingham Women's and Children's NHS Foundation Trust, UK; Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, UK. (9)University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. (10)Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada. (11)Division of Pediatric Surgery, Department of Surgery. Rocky Mountain Hospital for Children, Denver, CO 80205, USA. (12)Division Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, Pediatric Surgery, Utrecht, EA 3584, Netherlands. (13)Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. (14)Department of Surgery, Boston Children's Hospital, Boston, MA, USA. (15)Comprehensive Colorectal Center, Section of Colorectal and Pelvic Reconstructive Surgery, Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, MO, 64108, USA; University of Missouri- Kansas City, Kansas City, MO 64108, USA. Electronic address: rrentea@cmh.edu. BACKGROUND AND AIMS: Indocyanine Green Fluorescence (ICG-F)- guided surgery is becoming an increasingly helpful tool in pediatric surgical care. This consensus statement investigates the utility of ICG-F in various pediatric surgical applications, primarily focusing on its evidence base, safety, indications, use across different surgical specialties and dosing strategies. The aim is to establish an international consensus for ICG-F use in pediatric surgery. METHODS: An international panel of 15 pediatric surgeons from 9 countries was assembled. The structured process consisted of a rapid scoping review, iterative discussion sessions, mixed-methods studies with key stakeholders, and voting rounds on individual statements to create draft consensus statements. RESULTS: 100 articles were identified during the review and summarized by application. Based on this condensed evidence, consensus statements were generated after 3 iterative rounds of anonymous voting. Key areas of agreement were quality of evidence, the safety of ICG, pediatric surgical indications, utilization per surgical specialty, and dosing of ICG. CONCLUSION: This consensus statement aims to guide healthcare professionals in managing ICG-F use in pediatric surgical cases based on the best available evidence, key stakeholder consultation, and expert opinions. Despite ICG-F's promising potential, the need for higher-quality evidence, prospective trials, and safety studies is underscored. The consensus also provides a framework for pediatric surgeons to utilize ICG-F effectively. LEVEL OF EVIDENCE: III. Copyright © 2024 Elsevier Inc. All rights reserved. DOI: 10.1016/j.jpedsurg.2024.07.042 PMID: 39179501 [Indexed for MEDLINE] Conflict of interest statement: Conflict of interest All authors have no disclosures or conflicts of interest.