Near-infrared fluorescence with indocyanine green for minimally invasive hernia surgery: A systematic review and evidence synthesis

Table 1 Basic characteristics of the included studies

Ref.	Hernia	Reason for ICG administration	Dosage of ICG administration	Details of ICG administration (timings)	Outcomes
Zhang et al[9], 2024	Inguinal	Perfusion/viability assessment; lymphatic mapping; vascular anatomy/avoid injury; anatomical delineation	25 mg ICG diluted in 10 mL saline	Intraoperative; Intraoperatively; following this; following inguinal	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed
Nakaseko et al[10], 2023	Inguinal	Lymphatic mapping; vascular anatomy/avoid injury	0.25 mg; 2.5 mg; 0.25 mg	Intraoperative; following open; following endoscopic	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed
Nakashima et al[11], 2022	Inguinal	Perfusion/viability assessment; vascular anatomy/avoid injury	5 mg; 0.63 mg; 34.1 mg	Intraoperative; intraoperative	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed; no ICG-related adverse events
Ryu et al[12], 2016	Inguinal	Perfusion/viability assessment; vascular anatomy/avoid injury	5 mg	Intraoperative; intraoperative	Feasible/helpful; guided decisions/avoided injury or resection
Aarsh et al[13], 2024	Inguinal	Perfusion/viability assessment; vascular anatomy/avoid injury; anatomical delineation	NR	Intraoperative	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed
Shimada et al[14], 2022	Inguinal	Perfusion/viability assessment; lymphatic mapping; vascular anatomy/avoid injury; anatomical delineation	2.5 mg; 5 mg; 0.25 mg	Intraoperative; intraoperative; intra-operative; prior to laparoscopic	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed; no ICG-related adverse events
Daskalopoulou et al[15], 2018	Inguinal	Perfusion/viability assessment; lymphatic mapping; anatomical delineation	NR	Intraoperative; intraoperative; following hernia; following injection	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed; no ICG-related adverse events
Nakaseko et al[16], 2023	Inguinal	Perfusion/viability assessment; lymphatic mapping; vascular anatomy/avoid injury; anatomical delineation	NR	Intra-operative; intra-operative; intra-operatively; prior to surgery	Feasible/helpful; guided decisions/avoided injury or resection; complications reported/assessed; no ICG-related adverse events
Todeschini et al[17], 2024	Inguinal	Vascular anatomy visualization; prevention of iatrogenic vascular injury; anatomical delineation	NR	Intravenous; intraoperative; before peritoneal dissection; repeated before mesh fixation	Feasible/helpful; clear visualization of iliac and spermatic vessels within 45 seconds; guided surgical decisions; no complications reported
Yodying[18], 2024	Left paraduodenal hernia (strangulated)	Bowel perfusion intra-operatively to guide resection decision	NR	Intraoperative	Guided decision on bowel resection, laparoscopic repair achieved despite challenging presentation, no ICG-related adverse events reported
Wormer et al[19], 2016	Complex abdominal wall reconstruction	Assess tissue perfusion to reduce wound complications	NR	ICG-FA performed after repair and before flap closure; surgeons blinded vs non-blinded to imaging	ICG-FA identified hypoperfused areas; modification did not significantly reduce wound complications (15.6% vs 12.5%)
Ahmed et al[20], 2022	Mixed surgical cases, including hernia repairs	Assess vascularity, bowel viability, lymphatic mapping, and flap vascularity	NR	Intraoperatively	Feasible across procedures; potential for improved anatomic/vascular assessment; hernia-specific outcomes not separately reported
Tsuchiya et al[21], 2022	Hernia	Intestinal perfusion assessment: Evaluation of bowel and mesenteric blood flow	NR	Intraoperative; intravenous; during laparoscopic parastomal hernia repair	Feasible/helpful; confirmed adequate intestinal perfusion; guided safe repair; no postoperative complications; no recurrence at 6 months
Glanzer et al[22], 2021	Hernia	Identification and protection of ureters	NR	Intraoperatively, intraurethral injection	Feasible/helpful; guided decisions/avoided injury
Kozadinos et al[23], 2021	Hernia	Perfusion/viability assessment	NR	Intraoperatively; IV	Feasible/helpful; guided decisions/avoided resection (excellent perfusion, no resection needed)
Colavita et al[24], 2016	Hernia	Perfusion mapping to predict wound complications	0.25 mg	Intraoperatively, IV; performed twice: Prior to incision and prior to closure	Strong predictor of wound complications; significant association between poor perfusion and complications
Cengiz et al[25], 2017	Hernia	Perfusion/viability assessment	5 mg	Intraoperatively; IV	Feasible/helpful; guided decisions/avoided resection

ICG: Indocyanine green fluorescence; ICG-FA: Indocyanine green fluorescence angiography; NR: Not retrievable.