Evolving applications of fluorescence guided surgery in pediatric surgical oncology: A practical guide for surgeons

J Pediatr Surg. 2021 Feb;56(2):215-223. doi: 10.1016/j.jpedsurg.2020.10.013. Epub 2020 Oct 19.


Fluorescence-guided surgery (FGS) is an increasingly available and popular method of visual field augmentation. The basic premise of FGS entails injection of fluorescent indocyanine green (ICG) and subsequent detection with a near-infrared (NIR) camera. For pediatric surgical oncologists, FGS remains experimental but is a promising modality for identifying tumor margins, locating metastases, performing sentinel lymph node biopsies, protecting peritumoral structures of interest, and facilitating reconstruction. Familiarity with basic ICG pharmacokinetics and NIR detection optics is critical for surgeons wishing to judiciously use FGS, as its success is firmly grounded in a thorough understanding of its capabilities and limitations. In this practical guide, we outline several well-described and innovative FGS applications by disease type, including their methods of administration, modes of detection, and typical ICG dosing paradigms. LEVEL OF EVIDENCE: V.

Keywords: Fluorescence; Indocyanine green; Metastasectomy; Sentinel lymph node.

Publication types

  • Review

MeSH terms

  • Child
  • Coloring Agents
  • Fluorescent Dyes
  • Humans
  • Indocyanine Green
  • Lymph Nodes
  • Lymphatic Metastasis
  • Sentinel Lymph Node Biopsy
  • Surgeons*
  • Surgical Oncology*


  • Coloring Agents
  • Fluorescent Dyes
  • Indocyanine Green