Search Results (514)

In recent years, increasing attention has been given to adjunctive therapies aimed at improving clinical outcomes in periodontal treatment. Among these, antimicrobial photodynamic therapy (aPDT) using the photosensitizer indocyanine green (ICG) has shown great promise. Objective: This narrative review seeks to summarize the existing evidence from randomized controlled trials, systematic reviews, and in vitro and in vivo studies on the use of antimicrobial photodynamic therapy with indocyanine green (ICG) as a photosensitizer, as well as the emerging approach of double-light aPDT with ICG, in the treatment of periodontitis. Materials and Methods: PubMed, Web of Science, and Cochrane Library databases were searched to find relevant articles regarding the topic. The articles were published in English between the years 2015 and 2025. The search used keywords such as (“indocyanine green” AND “antimicrobial photodynamic therapy” AND (“efficiency” OR “efficacy” OR “effect”) AND (“periodont*” OR “gingivitis” OR “gingival” OR “gum”). The articles chosen were required to evaluate the treatment outcomes of periodontitis with ICG-aPDT. Conclusions: ICG-aPDT represents an effective adjunct treatment in periodontal therapy. It can non-invasively target biofilms and minimize systemic action. It makes this technique an attractive adjunct in modern periodontology practice. This narrative review shows that ICG-aPDT can be integrated into comprehensive periodontal care as an adjunct measure promoting tissue healing. However, more high-quality clinical trials are needed to develop standardized protocols and demonstrate long-lasting benefits. Full article

Urologic oncological surgery increasingly makes use of robotic systems to realize precise and minimally invasive resections, convent to shorter hospital stays and faster recovery times. The dexterity gains enabled through procedures such as robot-assisted (RA) prostatectomy have helped realize significant advancements in recent years. Complementing these effects via the used of hybrid tracers that illuminate surgical targets, i.e., cancerous tissue, has helped advance the surgical decision making via enhanced visualization. A well-known example is Indocyanine green (ICG)-Technetium-99m (^99mTc)-nanocolloid, a hybrid extension of the radiopharmaceutical ^99mTc-nanocolloid. These hybrid tracers provide a direct link between preoperative imaging roadmaps and intraoperative target identification, and improve efficiency, accuracy, and confidence of the urologist in procedures such as sentinel lymph node biopsy (SLNB). Receptor-targeted hybrid tracer analogues, for e.g., prostate specific membrane antigen (PSMA), are also being explored as an extension of the ongoing efforts that use radiotracers such as ^99mTc-PSMA-I&S. Together, these efforts jointly pave the way for novel techniques in intraoperative lesion localization in other urological malignancies. This narrative review discusses the potential use of hybrid tracers in robotic oncological urology, including different imaging techniques and their applications for tumor localization for prostate, bladder, and kidney cancer. Full article

Sentinel lymph node biopsy (SLNB) has transformed the management of cutaneous melanoma, emerging as a cornerstone in evaluating regional lymphatic spread while minimizing surgical morbidity. From its theoretical foundation laid by Cabanas to its refinement and clinical validation through landmark trials, SLNB has evolved into a standard of care with significant prognostic value. This review traces the historical trajectory of SLNB, analyzes current guidelines and controversies and explores future directions. Novel imaging technologies, such as indocyanine green fluorescence and augmented reality-assisted mapping, promise to enhance accuracy and reduce invasiveness. Furthermore, the advent of effective systemic therapies and neoadjuvant protocols is reshaping the therapeutic landscape, potentially redefining the role of SLNB in melanoma management. As precision medicine advances, SLNB remains an essential procedure, with its utility continually redefined by technological innovation and evolving oncologic strategies. Full article

Maximal safe surgical resection remains a critical component of glioblastoma (GBM) management, improving both survival and quality of life. However, complete tumor removal is hindered by the infiltrative nature of GBM and its proximity to eloquent brain regions. Fluorescence-guided surgery (FGS) has emerged as a valuable tool to enhance intraoperative tumor visualization and optimize resection outcomes. Currently used fluorophores such as 5-aminolevulinic acid (5-ALA), fluorescein sodium (FS), and indocyanine green (ICG) have distinct advantages but are limited by suboptimal specificity, shallow tissue penetration, and technical constraints. 5-ALA and SF often yield unreliable signals in low-grade tumors or infiltrative regions and also pose challenges such as phototoxicity and poor depth resolution. In contrast, near-infrared (NIR) fluorescence imaging represents a promising next-generation approach, providing superior tissue penetration, reduced autofluorescence, and real-time delineation of tumor margins. This review explores the mechanisms, clinical applications, and limitations of currently approved FGS agents and highlights future directions in image-guided neurosurgery. Full article

Background/Objectives: Back table fluorescence imaging performed on freshly excised tissue specimens represents a critical step in fluorescence-guided surgery, enabling rapid assessment of tumor margins before final pathology. While most preclinical NIR-II imaging platforms, such as the IR VIVO (Photon, etc.), offer high-resolution and depth-sensitive imaging under controlled, enclosed conditions, they are not designed for intraoperative or point-of-care use. This study compares the IR VIVO with the LightIR system, a more compact and clinically adaptable imaging platform using the same Alizé 1.7 InGaAs detector, to evaluate whether the LightIR can offer comparable performance for back table NIR-II imaging under ambient light. Methods: Standardized QUEL phantoms containing indocyanine green (ICG) and custom agar-based tissue-mimicking phantoms loaded with IR-1048 were imaged on both systems. Imaging sensitivity, spatial resolution, and depth penetration were quantitatively assessed. LightIR was operated in pulse-mode under ambient lighting, mimicking back table or intraoperative use, while IR VIVO was operated in a fully enclosed configuration. Results: The IR VIVO system achieved high spatial resolution (~125 µm) and detected ICG concentrations as low as 30 nM in NIR-I and 300 nM in NIR-II. The LightIR system, though requiring longer exposure times, successfully resolved features down to ~250 µm and detected ICG to depths ≥4 mm. Importantly, the LightIR maintained robust NIR-II contrast under ambient lighting, aided by real-time background subtraction, and enabled clear visualization of subsurface IR-1048 targets in unshielded phantom setups, conditions relevant to back table workflows. Conclusions: LightIR offers performance comparable to the IR VIVO in terms of depth penetration and spatial resolution, while also enabling open-field NIR-II imaging without the need for a blackout enclosure. These features position the LightIR as a practical alternative for rapid, high-contrast fluorescence assessment during back table imaging. The availability of such clinical-grade systems may catalyze the development of new NIR-II fluorophores tailored for real-time surgical applications. Full article

Accurate intraoperative localization of deep-seated lesions remains a major challenge in minimally invasive procedures such as laparoscopic and robotic surgeries. Current marking strategies—including ink tattooing and metallic clips—are limited by dye diffusion, or poor intraoperative visibility. To address these issues, we developed and evaluated four thermosensitive injectable hydrogel systems incorporating indocyanine green-human serum albumin (ICG-HSA) complexes: (1) hexanoyl glycol chitosan (HGC), (2) Pluronic F-127, (3) PCL–PEG–PCL, and (4) PLA–PEG–PLA. All hydrogel formulations exhibited sol–gel transitions at physiological temperatures, facilitating in situ dye entrapment and prolonged fluorescence retention. In vivo fluorescence imaging revealed that HGC and Pluronic F-127 hydrogels retained signals for up to five and two days, respectively. In contrast, polyester-based hydrogels (PCL–PEG–PCL and PLA–PEG–PLA) preserved fluorescence for up to 21–30 days. PLA–PEG–PLA showed the highest signal-to-background ratios and sustained intensity, while PCL–PEG–PCL also achieved long-term retention. These findings suggest that thermosensitive hydrogels incorporating ICG-HSA complexes represent promising tissue marker platforms for real-time, minimally invasive, and long-term fluorescence-guided lesion tracking. Full article

Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used more commonly in the adult population, its adoption in pediatric surgery has been increasing more frequently. This comprehensive review aims to elucidate the myriad of ICG surgical applications within the pediatric population and important clinical considerations for administration. Methods: PubMed was queried for pediatric surgical applications of indocyanine green. Surgical application, route of administration, dosage, ICG-related complications, and surgical impact of ICG fluorescence were analyzed. Results: In the pediatric population, ICG is used in a multitude of hepatobiliary, gastrointestinal, cardiothoracic, lymphatic, urologic, gynecologic, plastic, ENT, ophthalmologic, and neurosurgical procedures. Applications range from oncologic resections to benign and congenital reconstructions. Administration can be intravenous, intralesional, subcutaneous, inhaled, or enteric. Timing, dosage, and route of administration are dependent on the pathology of interest. Conclusions: ICG is a safe and useful adjunct for a wide variety of pediatric surgical applications. This comprehensive review aims to highlight administration considerations and the efficacy of ICG fluorescence in various surgical subspecialty pathologies. Future studies should continue to focus on how to integrate pathology-specific ICG fluorescence into intraoperative decision-making. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

Background: A precise drug delivery system enables the optimization of treatments with minimal side effects if it can deliver medication only when activated by a specific light source. This study presents a controlled drug delivery system based on poly(lactic-co-glycolic acid) (PLGA) microparticles (MPs) designed for the sustained release of vancomycin hydrochloride. Methods: The MPs were co-loaded with indocyanine green (ICG), a near-infrared (NIR) responsive agent, and fabricated via the double emulsion method.They were characterized for stability, surface modification, biocompatibility, and antibacterial efficacy. Results: Dynamic light scattering and zeta potential analyses confirmed significant increases in particle size and surface charge reversal following chitosan coating. Scanning electron microscopy revealed uniform morphology in uncoated MPs (1–10 $\mathsf{\mu }$m) and irregular surfaces post-coating. Stability tests demonstrated drug retention for up to 180 days. Among formulations, PVI1 exhibited the highest yield (76.67 ± 1.3%) and encapsulation efficiency (56.2 ± 1.95%). NIR irradiation (808 nm) enhanced drug release kinetics, with formulation PVI4 achieving over 48.9% release, resulting in improved antibacterial activity. Chitosan-coated MPs (e.g., PVI4-C) effectively suppressed drug release without NIR light for up to 8 h, with cumulative release reaching only 10.89%. Without NIR light, bacterial colonies exceeded 1000 CFU; NIR-triggered release reduced them below 120 CFU. Drug release data fitted best with the zero-order and Korsmeyer–Peppas models, suggesting a combination of diffusion-controlled and constant-rate release behavior. Conclusions: These results demonstrate the promise of chitosan-coated NIR-responsive PLGA MPs for precise, on-demand antibiotic delivery and improved antibacterial performance. Full article

Background: Singlet oxygen (¹O₂) generation in biological samples remains a significant challenge. Studying the mechanism of ¹O₂ action during photodynamic therapy (PDT) in atherosclerotic plaques in vitro represents an innovative cardiological approach. Atherosclerosis, a chronic and progressive disease, is characterized by plaque buildup inside arterial walls. Objectives: This study focused on the use of spin–lattice (T₁) and spin–spin (T₂) relaxation times measured by Magnetic Resonance Imaging (MRI) before and after the administration of indocyanine green-mediated PDT (ICG-PDT). Methods: To enhance visualization of morphological changes in atherosclerotic plaques, the clinically approved MRI contrast agent Gadovist was utilized. A total of 12 atherosclerotic plaque samples were collected from six patients undergoing endarterectomy. The generation of ¹O₂ in these plaques was assessed using quantitative MRI measurements and microscopic imaging, which visualized structural changes induced by PDT. Results: This research explores the potential of T₁ and T₂ relaxation times as indicators of PDT efficacy, while Gadovist helped provide evidence of ¹O₂ diffusion within the samples. Conclusions: Considering advancements in modern treatment, PDT may offer a novel approach for targeting atherosclerosis. Full article

Introduction: Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is now widely regarded as a valuable aid in decision-making for complex hepatobiliary procedures, with increasing support from recent studies. Methods: We performed a systematic review following PRISMA guidelines, utilizing PubMed, CINAHL, and EMBASE databases to locate studies on the perioperative use ICG in pediatric hepatobiliary surgeries. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. We collected data on study design, patient demographics, surgical indications, ICG dosing, timing of ICG injection, and perioperative outcomes. Results: Forty-three articles, including 930 pediatric patients, from 1989 to 2025 met the inclusion criteria for narrative synthesis in our systematic review, of which 22/43 (51.2%) were retrospective studies, 15/43 were case reports (34.9%), 3/43 (7.0%) were experimental studies, and the other three were prospective comparative studies (7.0%). The current clinical applications of ICG in hepatobiliary pediatric surgery include bile duct surgery (cholecystectomy, choledochal cyst, biliary atresia), reported in 17 articles (39.5%), liver tumor resection, reported in 15 articles (34.9%), liver transplantation, reported in 6 articles (14.6%), and liver function determination, reported in 5 articles (12.2%). Conclusions: ICG fluorescence navigation in pediatric hepatobiliary surgery is a highly promising and safe technology that allows for the intraoperative localization of anatomic biliary structures, aids in the identification and resection of liver tumors, and can accurately determine hepatic function. The lack of comparative and prospective studies, and the variability of the dose and timing of administration are the main limitations. Full article

Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between January 2019 and June 2024. All patients were diagnosed using preoperative imaging findings and intraoperative indocyanine green (ICG) lymphography. The baseline data of enrolled cases were retrospectively collected. The clinical characteristics were documented, including gender, age, histological typing, location, maximum diameter, and intracystic condition. Patients with or without ICH were divided into two groups. The dependent variables for predicting an excellent outcome were analyzed using multivariable logistic regression models after adjusting for potential factors using a univariable regression model. Postoperative variables, including duration of negative drainage, local infection, scar hyperplasia, and follow-up, were compared between the two groups. Results: A total of 83 cLM patients were included (ICH group: n = 36 and without ICH group: n = 47). A complete absence of afferent lymphatic vessels was demonstrated using intraoperative ICG lymphography, suggesting the isolated nature of ICH cases. ICH (p = 031; OR, 2.560; 95% CI, 1.089–6.020) was identified as the main predictor, and younger patients (p = 035; OR, 0.415; 95% CI, 0.183–0.940) had a lower potential for excellent outcomes. For the postoperative variables, the ICH group exhibited a shorter duration of negative drainage than the without ICH group (p < 0.001), while no significant differences were found regarding local infection (p = 0.693) and scar hypertrophy (p = 0.648). Conclusions: Although characterized by aggressive progression and compressive symptoms, ICH emerges as an independent favorable prognostic predictor in macro/mixed cLM management, potentially attributable to its isolated nature. Full article

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management. Full article

(1) Background: Lymphedema is a common but underrecognized sequela of cancer treatment. Supermicrosurgical procedures such as lymphaticovenular anastomosis (LVA) and, more recently, lymph node-to-vein anastomosis (LNVA) have emerged as effective options for fluid-predominant disease. In 2024, we began performing robot-assisted LNVA using a next-generation microsurgical robot. This study describes our initial experience, technical insights, and the potential for robotics to extend the boundaries of supermicrosurgery. (2) Methods: Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon at a tertiary center. Preoperative imaging with standard and ultra-high frequency ultrasound was used to identify optimal lymph nodes and veins. Robotic LNVA was performed using the Symani Surgical System, with adaptations for motion scaling, ergonomics, and console control. Intraoperative patency was confirmed by direct washout and/or indocyanine green (ICG) transit. (3) Results: All 22 procedures were technically successful, with 100% intraoperative patency. Anastomosis time improved from 37 to 18 min. Robotic assistance enhanced precision, eliminated tremors, and reduced the technical burden of operating at extreme submillimeter scales. (4) Conclusions: Robotic LNVA is safe, feasible, and efficient. It optimizes current techniques, offering the potential to extend surgical access below the 0.1 mm threshold, with implications for future treatment of lymphatic and possibly intracranial disease. Full article

Photodynamic therapy (PDT) using indocyanine green (ICG) has gained attention as an adjunctive treatment for periodontitis due to its antimicrobial and anti-inflammatory properties and its ability to penetrate deep periodontal tissues via near-infrared light activation. We aimed to evaluate the clinical and microbiological efficacy of ICG-mediated PDT as an adjunct to conventional periodontal therapy in patients with periodontitis based on data from randomized controlled trials (RCTs). A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted to identify randomized controlled trials (RCTs) exclusively investigating ICG-PDT in periodontitis based on predefined eligibility criteria. Studies were selected based on predefined inclusion criteria, and methodological quality was assessed using a 14-point scoring system. Data were extracted on clinical outcomes (e.g., probing depth, clinical attachment level) and microbiological changes. Sixteen RCTs met the inclusion criteria. Most studies reported improvements in probing depth, clinical attachment level, and microbial reduction following ICG-aPDT; however, some trials found no significant differences compared to control groups. These discrepancies may be attributable to variations in laser settings, ICG concentration, treatment frequency, or initial disease severity. Microbiological benefits included significant reductions in key periodontal pathogens. The therapy was well tolerated, with no adverse effects reported. However, variability in treatment protocols and limited long-term follow-up restricted the ability to draw definitive conclusions. ICG-mediated PDT is a promising, safe, and effective adjunct in periodontal therapy. Future trials should aim for protocol standardization and long-term outcome assessment to strengthen clinical guidance. Full article