Fluorescence-Guided Surgery Program
Fluorescence-guided surgery at Lurie Children’s is an enhancement of traditional surgical techniques that provides surgeons with new layers of information to improve surgical safety and clinical outcomes. The approach is used by pediatric surgeons in our Divisions of Pediatric Surgery, Urology, Plastic & Reconstructive Surgery and Transplant and Advanced Hepatobiliary Surgery.
By injecting an FDA-approved dye called indocyanine green (or ICG) through an IV into a patient’s body and using special cameras to see the dye glow inside the body, surgeons are able to be even more comprehensive and precise in their operations.
Among its many applications, fluorescence-guided surgery can help surgeons:
- Confirm that tissue has optimal blood supply for healing after surgery.
- Augment the visualization of structures around the liver to avoid rare but serious complications during hepatobiliary surgery.
- Ensure that there is a water-tight connection, without any leak, after reconstruction of the urinary system.
- Guide lymph node sampling in patients with some tumors to determine if any cancer cells have spread to the nearby lymph nodes.
- Aid identification of tumor nodules, particularly in the lung, to help ensure complete removal of all disease.
- Identify devitalized tissue or tissue that lacks blood supply and should be removed.
In many cases, fluorescence-guided surgery can be utilized as part of a minimally invasive technique, which usually leads to better outcomes and faster recovery from a range of procedures. The enhanced visualization from the fluorescence can allow a minimally invasive approach in some patients who would have otherwise required a more invasive “open” operation.
The Lurie Children’s Difference
Lurie Children’s is among the only children’s hospitals in the country with a comprehensive Fluorescence-Guided Surgery Program. Lurie Children’s surgeons are continuously finding new ways to use the contrast dye used in fluorescence-guided surgery to improve outcomes for babies through young adults.
Conditions We Treat
- Cholecystectomy (gallbladder removal)
- Pulmonary metastasectomy (removal of tumor which has spread to the lung)
- Sentinel Lymph Node Biopsy
- Pyeloplasty and other urologic reconstruction
- Liver resection (removal of liver tumors)
- Intestinal surgeries
- Thyroid operations
- Pedicled muscle flaps for complex reconstruction
- Free tissue transfer for complex reconstruction
Seth D. Goldstein, MD, MPhil
Attending Physician, Pediatric Surgery; Director; Surgical Simulation Program, Member, Lurie Children's Surgical Foundation
Assistant Professor of Surgery, Northwestern University Feinberg School of Medicine
Mehul V. Raval, MD, MS, FAAP, FACS
Attending Physician, Pediatric Surgery; Vice Chair of Quality and Safety; Department of Surgery; Member, Lurie Children's Surgical Foundation
Professor of Surgery (Pediatric Surgery) and Pediatrics, Northwestern University Feinberg School of Medicine
Plastic & Reconstructive Surgery
Noopur Gangopadhyay, MD
Attending Physician, Plastic & Reconstructive Surgery; Member, Lurie Children's Surgical Foundation
Associate Professor of Plastic Surgery, Northwestern University Feinberg School of Medicine
Transplant and Advanced Hepatobiliary Surgery
Riccardo A. Superina, MD
Division Head, Transplant Surgery; Co-Director, Siragusa Transplantation Center; Surgical Director, Intestinal and Liver Transplant Programs; Robert E. Schneider Chair in Transplantation; Member, Lurie Children's Surgical Foundation
Professor of Surgery, Northwestern University Feinberg School of Medicine
Edward M. Gong, MD
Attending Physician, Urology; Co-Director, Fetal Urology, The Chicago Institute for Fetal Health; Member, Lurie Children's Surgical Foundation
Assistant Professor of Urology, Northwestern University Feinberg School of Medicine
What to Expect
If a fluorescence-guided surgery is right for your child, their surgical team will walk you through the steps, from before the operation to recovery.
Generally, in fluorescence-guided surgery, a contrast dye called indocyanine green (ICG) is injected intravenously into a child and automatically goes to anywhere in the body where blood is flowing. In some cases, the dye is injected on the day of surgery, but in other cases it needs to be injected 1-3 days prior to surgery.
Immediately after injection, the dye travels through the bloodstream and can be used to assess whether the tissue has sufficient blood supply or “perfusion” for perfect healing. A short time later (about 30-90 minutes), the dye will concentrate anywhere bile exists in the body
During gallbladder removal procedure, using this approach can help minimize the minor risk of injuring the main bile duct that drains bile from the liver.
For cancer-related surgeries, the dye concentrates in tumor tissues, so surgeons, with the help of special cameras that make the dye “glow,” can easily see exactly which parts of tumor tissue or lesions are cancerous and should be removed. This helps the surgeons remove cancerous tumors and lesions in their primary locations, but also where cancer may have metastasized, or spread, to other organs.
When complex reconstruction is required, either for a traumatic injury, an oncologic defect, or a congenital difference, this technique can be used to identify tissue that has poor blood supply and should be removed. It can also be used to show the zone of perfusion of a blood vessel or confirm the viability of a pedicled flap or a free flap.