Knowledge, attitudes and practices of using Indocyanine Green (ICG) fuorescence in emergency surgery: an international web‑based survey in the ARtifcial Intelligence in Emergency and trauma Surgery (ARIES)—WSES project

Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difcult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtifcial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artifcial intelligence. The response rate was 96% (192/200). Responders afrmed that ICG fuorescence can support the performance of difcult surgical procedures in the emergency setting, particularly in the resence of severe infammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fuorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fuorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of espondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) afrmed that ICG fuorescence changed always their intraoperative decision-making. Precision surgery efectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artifcial intelligence. ICG fuorescence can serve as a valid and safe tool to guide emergency surgery in diferent scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of highlevel evidence within this feld, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fuorescence imaging systems and to support emergency surgeons in implementing ICG fuorescence in their daily practice.