# The introduction of fluoroscopic surgery: A report of an initial trial case

## TL;DR

This case report introduces a new fluoroscopic surgery technique using continuous ICG infusion to keep blood vessels visible without switching light modes.

## Contribution

This is the first study to use continuously infused ICG during surgery.

## Key findings

- Continuous ICG angiography allowed the appendiceal artery to remain visible throughout the operation.
- The fluoroscopic surgery technique was feasible without switching to white light mode.
- The method was successfully tested in an appendectomy as an initial trial.

## Abstract

Switching from white light to fluorescence mode is necessary to confirm the fluorescence during fluorescence-guided surgery. This case report presents the use of a syringe pump to continuously inject indocyanine green (ICG), which enabled the vessels to be visualised and the operation to be performed without switching.

An Asian male patient in his 40s underwent an interval appendectomy following conservative treatment for appendicitis. Laparoscopic surgery was performed using the VISIONSENSE® system. Diluted ICG (25 mg/15 mL) was intravenously administered at 1 mL/min.

The appendiceal artery was visualised in light green, and the intensity of the visualisation was defined relative to the tissue surrounding the dissected appendiceal artery. The superior rectal artery and the vessels within the mesentery of the small intestine were confirmed to be continuously visualised throughout the surgery.

Therefore, continuous ICG angiography made it possible to operate while keeping the appendiceal artery visible in this case.

ICG angiography enabled the operation to be performed with the appendiceal artery continuously visualised. This method was developed for use in cancer surgery; however, since operations of longer duration are speculated to require larger doses of ICG, we opted to introduce this method in an initial trial for appendectomy.

The fluoroscopic surgery using a syringe pump was feasible in this first case report without switching to white light mode.

•We report a fluoroscopic surgery technique where ICG was continuously infused.•This is the first study to use continuously infused ICG during surgery.•The appendiceal artery remained visible while using continuous ICG angiography.

We report a fluoroscopic surgery technique where ICG was continuously infused.

This is the first study to use continuously infused ICG during surgery.

The appendiceal artery remained visible while using continuous ICG angiography.