Advancing Pediatric Surgery with Indocyanine Green (ICG) Fluorescence Imaging: A Comprehensive Review

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Abstract
Background: Indocyanine green (ICG) fluorescence imaging has revolutionized pediatric surgery by enhancing precision, safety, and outcomes across various specialties. In recent years, its use has spread through the framework of pediatric surgery, where its ability to illuminate anatomical structures and pathological conditions has improved surgical outcomes. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was performed using the term “Indocyanine green” in all fields, including papers about pediatric patients (aged 0–18 years) published between January 2014 and July 2024. Results: This review systematically explores ICG applications, dosing regimens, timing of administration, and integration into modern surgical technologies, including robotics and minimally invasive platforms. ICG resulted in an excellent safety profile and enables the real-time visualization of anatomical structures and pathological conditions, proving invaluable in pediatric cases characterized by smaller anatomical dimensions and congenital anomalies. Conclusions: This review highlights ICG fluorescence imaging as an indispensable tool in pediatric surgery, offering transformative potential for improving surgical outcomes and patient safety. Despite its advantages, it is necessary to standardize dosing and timing protocols to maximize its utility. The aim of this review is to explore the various applications of ICG in pediatric surgery, report the dosage and administration times across different surgical fields, and establish best practices to guide its future use.

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