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

Table 4 Indications for intraoperative indocyanine green fluorescence imaging stratified by clinical urgency and hernia subtype

Clinical context	Inguinal hernia	Ventral/incisional hernia	Complex abdominal wall (e.g., parastomal, large/redo/robotic reconstructions)
Elective	Anatomical/vascular delineation: Identification of inferior epigastric vessels, cord structures, and dissection planes during TEP/TAPP; lymphatic mapping: Visualization of spermatic cord lymphatics	Perfusion assessment: Evaluation of abdominal wall/skin-flap perfusion to inform incision planning, flap design, and mesh placement in selected cases; anatomical delineation: Adjunctive mapping of vascular territories in abdominal wall reconstruction	Perfusion assessment: Mapping perfusion of mobilized tissues/flaps and abdominal wall domains during reconstruction; anatomical delineation: Adjunct identification of critical structures (e.g., ureter/vascular structures) when anatomy is distorted, or dissection is extensive
Emergency (incarcerated/strangulated)	Perfusion/viability assessment: Real-time appraisal of bowel perfusion after reduction to support intraoperative judgement regarding resection vs preservation; anatomical delineation (selected cases): Clarification of vascular anatomy in inflamed or distorted planes	Perfusion/viability assessment: Assessment of compromised bowel or abdominal wall tissue after reduction of incarcerated/strangulated ventral/incisional hernias; perfusion assessment: Evaluation of threatened skin/soft tissue in contaminated or high-risk settings (selected cases)	Perfusion/viability assessment: Evaluation of bowel perfusion in complex reductions (e.g., parastomal or large hernias) where viability is uncertain; anatomical delineation (selected cases): Identification of ureter or other critical structures during difficult reductions or redo operations

TEP: Totally extraperitoneal; TAPP: Transabdominal preperitoneal.