Döbling Private Hospital: "Luminous Tissue" Makes Operations Even Safer

Currently, minimally invasive surgery is performed with the help of high-resolution 3D and 4K cameras in order to ensure the most accurate and high-contrast representation of the tissue structures possible, and thus to allow precise and tissue-sparing surgery. In ICG-based fluorescence angiography, a special dye, indocyanine green (ICG), is also used. This substance is harmless to health and is injected into the patient's vein. The dye is then activated with a near-infrared (NIR) laser, which causes fluorescence and makes the affected tissue glow. In this way, a visual representation of the tissue perfusion is possible.

For OA Dr. Thomas Winkler, specialist in general surgery and visceral surgery, it is clear: “The technique of intraoperative fluorescence angiography can provide information about the perfusion situation and makes structures visible during operations that cannot be seen, or only poorly, under the usual white light of conventional cameras. This can significantly reduce complication rates and thus significantly increase patient safety. This is how our patients benefit from this latest technology.”

The main area of ​​application in general or visceral surgery is the visual representation of the blood flow in the ends of the intestine, which have to be stiched after a piece of intestine has been removed in order to ensure optimal healing of the reconnected ends of the intestine and to avoid serious complications. However, the technique is also used in many other operations. In the Döbling Private Hospital, the procedure is mainly used for gallbladder and thyroid gland operations. In the case of the latter, the technique is used to avoid dreaded complications such as hypothyroidism. This occurs when the almost microscopically small blood supply to the parathyroid glands is damaged during the procedure. “With ICG and NIR, we can immediately determine whether the blood flow is still functioning and, if necessary, react appropriately and quickly. As a result, complications can be reduced to a minimum,” says Winkler.

Due to the short half-life of the ICG, the surgical team must gather the maximum amount of information possible in a few minutes when the tissue is glowing. The dye is finally transported from the body to the liver, where it is broken down after 24 to 48 hours and excreted in the bile. “We can take advantage of this in biliary tract operations by administering ICG specifically one to two days before the operation. This is particularly helpful in preventing injuries to the bile duct in patients with a history of adhesions and inflammation,” explains the expert.

Newer areas of application are tumor surgery and here in particular the visualization of the lymphatic drainage pathways of the tumors. ICG-based fluorescence angiography enables particularly gentle, selective work, thorough removal of the tumor tissue and the maximum preservation of healthy tissue will. "In the future it will even be possible to couple antibodies to ICG or other fluorescent dyes in order to detect even the smallest tumor nests," Winkler is convinced.