Indiocyanine green fluorescence.guided surgery in the emergency setting: the WSES international consensus position paper

Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fuorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefts in elective surgeries. Aim This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fuorescence imaging in emergency settings. Methods Using the PICO framework, the consensus coordinator identifed key research areas, topics, and questions regarding the implementation of ICG fuorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in fnal approval. Results ICG fuorescence imaging, including angiography and cholangiography, improves intraoperative decisionmaking in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with signifcant infammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection.