Near-Infrared Fluorescence Guidance With Indocyanine Green in Adrenal-Sparing Surgery: A Systematic Review.

Abstract

Cortical-sparing adrenal surgery might require additional intraoperative navigation to optimize outcomes. Near-infrared fluorescence imaging with indocyanine green (NIR/ICG) has emerged as a promising adjunct to support this goal. A systematic search of international and Russian databases identified clinical and experimental studies (2013-2024) evaluating NIR/ICG during adrenal surgery. Fifteen studies met the inclusion criteria. Due to data heterogeneity and limited comparative evidence, a systematic review without meta-analysis was performed. Since the first report in 2013, subsequent studies consistently demonstrated differential fluorescence between adrenal tumors and normal tissue. NIR/ICG improved visualization of adrenal anatomy, aided margin delineation, facilitated tissue dissection, and enabled assessment of perfusion in residual adrenal tissue during cortical-sparing procedures. NIR/ICG is a safe and promising tool for intraoperative navigation in adrenal surgery. However, further research is needed to clarify fluorescence interpretation, define correlations with tumor biology, standardize protocols, and validate its role in assessing adrenal parenchyma viability.