Indocyanine green dyed gauze-guided minimum invasive surgery for anatomical landmarks and preventing gauze remnants: a pilot study

Purpose: We aimed to develop a novel fluorescent surgical gauze dyed with indocyanine green (ICG) to guide surgeons to the target anatomical destination during surgery for real-time navigation and to prevent gauze remnants after surgery.

Methods: Surgical gauze was dyed with an aqueous solution of ICG (5.0 × 10^{- 5} mol L^{- 1} for Steraze, 1.5 × 10^{- 4} mol L^{- 1} for BK-Opeze) at 132 °C (inside pressure: 2.82 atm, 286 kPa) for 15 min using an autoclave, followed by washing with distilled water, drying at room temperature, and sterilizing at 132 °C for 8 min before surgery. Fluorescence (FL) intensity was examined preclinically in the resected specimens using the SPY PHI (Stryker) system. Fourteen patients who underwent laparoscopic- and robotic-assisted gastroenterological surgery at Showa University Hospital were included.

Results: Fluorescent emission of ICG-dyed gauze was clearly observed through resected specimens with a thickness of approximately 10 mm or more. In a clinical trial, the ICG-dyed gauze was detected earlier with near-infrared (near-IR) FL imaging than under white light during seven cases of laparoscopic and robotic surgery, which could become a precise marker for surgeons to locate the dissection site despite overlaying tissues and nearby disturbances. Additionally, no seepage of ICG from the gauze was observed in all surgical fields.

Conclusion: We successfully developed ICG-dyed gauze exhibiting bright near-IR FL which can guide surgeons to the target anatomical destination and prevent gauze remnants during surgery. This invention would be a powerful support for real-time navigation surgery.