Supplementary file 1_Indocyanine green fluorescence-guided surgery in acute settings: state-of-the art.docx

One aspect is the complexity of acutely ill or injured patients with abnormal physiology, unoptimized comorbidities, and unplanned interventions. Traditional visual and tactile assessments of the surgical field anatomy and tissue viability have documented limitations.

The need for integrated technology to augment such assessments is described. Indocyanine green fluorescence-guided surgery (ICG-FGS) is a promising tool, given its history, safety, low cost, and accumulated experience in elective settings for many surgeries, to help transform precision surgery into acute settings (trauma and emergency surgery). An updated review is needed based on new evidence outlining the current landscape of ICG in acute settings.</p>Methods<p>We performed a comprehensive review of literature update in the last two decades through June 2026, covering PubMed, ClinicalTrials.gov, and published societal guidelines, including, but not limited to, the World Society of Emergency Surgery (WSES) consensus position paper and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) review.</p>Results<p>ICG is applicable across the full spectrum of acute surgical care, classified under two principal functions: anatomical mapping (biliary, ureteric, thoracic duct, and vascular structures) and perfusion assessment (bowel and mesenteric ischemia, anastomotic perfusion, pancreatic necrosis, burns, soft tissue, extremity trauma, and organ injury).