IMAGE1 S™ RUBINA™
mORe to discover
Overview of applications for
NIR/ICG fluorescence imaging
IMAGE1 S™ RUBINA™
mORe to discover
Our OPAL1® NIR/ICG technology enables the visualization
of indocyanine green (ICG) such as Verdye or Infracyanine
in near infrared (NIR).
In addition to displaying ICG, the detection of
autofluorescence in near infrared is also possible.
Overview of applications 3
The use of NIR/ICG technology allows the visualization
of various anatomic structures.
This includes the following:
Vascular Hepatobiliary Lymphatic
system system system
Following the administration of ICG
Parathyroid glands Ureter
without the via a ureter catheter
administration of ICG filled with ICG
(endogenous
autofluorescence)
Disclaimer
Please note that we – KARL STORZ – are not
pharmaceutical consultants and do not possess
expertise in the area of pharmaceutical products.
The medical opinions, techniques and procedures described
are presented exclusively as an educational service intended
for medical professionals ONLY and DO NOT necessarily
reflect the views or opinions of KARL STORZ SE & Co. KG.
This program DOES NOT constitute a representation that
the techniques or procedures described would necessarily
be appropriate or recommended treatment for any particular
individual patient. The decision to utilize and implement
any of the medical opinions, techniques and/or procedures
presented is up to the sole discretion and choice of the
individual medical practitioner.
Therefore, we exclusively refer to publications or statements
made by physicians.
In case of questions about a medicinal product, we therefore
ask you to contact the respective pharmaceutical company.
More information can also be found in the package leaflet
of the medicinal product.
Application overview 5
for NIR/ICG fluorescence imaging
with OPAL1® NIR/ICG technologies
from KARL STORZ
The applications below represent possible areas of
application for NIR/ICG technology. Data related to the
medicinal product and its administration are taken from
the publications or persons indicated in the footnotes.
These are not recommendations for use on the part of
KARL STORZ.
Further information on the individual applications can be
obtained from the corresponding publications.
Please inform yourself accordingly in advance for which
application the respective preparation is approved in
your country.
Applications in General Surgery
Cholecystectomy/Cholangiography
Purpose: Injection time: 6-10 h
Bile duct prior to surgery or at
visualization least 30 min. before
(higher concentration
of ICG in the liver)
Injection type: First ICG detection:
Intravenous With start of surgery
Used dosage: ICG duration:
0.1-0.2 mg/kg Remains stable
during surgery
Note:
If the individual anatomy
of the cystic artery calls for
intra-operative assessment,
a small bolus of ICG can be
injected intravenously to see
the vascular structures.
Application image: Prof. L. Boni, Policlinico Milano, Italy
Page content: 2019, Boni et al., ICG-enhanced fluorescence-guided
laparoscopic surgery
Applications in General Surgery 7
Colorectal Resection
Purpose: Injection time:
Perfusion assessment After mesenteric division
and after anastomosis
(abdominal and rectal)
Injection type: First ICG detection:
Intravenous Quickly after injection
Used dosage: ICG duration:
0.2 mg/kg Remains stable for only
a short period of time
Application image: Prof. L. Boni, Policlinico Milano, Italy
Page content: 2
019, Boni et al., ICG-enhanced fluorescence-guided
laparoscopic surgery
Applications in General Surgery
Esophagectomy
Purpose: Injection time:
Gastric conduit Before and after
perfusion evaluation anastomotic
construction
Injection type: First ICG detection:
Intravenous Quickly after injection
Used dosage: ICG duration:
15 mg/bolus After 15-20 minutes a
new measurement is
possible
Page content and application image:
Prof. S. Morales Conde, Hospital Quironsalud Sagrado Corazón,
Seville, Spain
Applications in General Surgery 9
Liver Segmentation
Purpose: Injection time:
Visualization of liver Prior to the procedure
segments
Injection type: First ICG detection:
Intravenous; respective 30-60 sec. after injection
segment needs to be
clipped in advance
Used dosage: ICG duration:
0.1-0.3 mg/kg Remains stable during
surgery
Note:
Alternatively, it could be a
superselective intra-hepatic
arterial injection to flush only
the respective segment.
Page content and application image:
Prof. G. Wakabayashi, Ageo Central General Hospital, Japan
Applications in General Surgery
Liver Metastasis
Purpose: Injection time:
Visualization of hepatic 36 h prior to surgery
metastases
Injection type: First ICG detection:
Intravenous With start of surgery;
cells around the
metastatic lesion are
deficient in bile secretion
Used dosage: ICG duration:
0.4 mg/kg Remains stable during
surgery
Note:
Hepatocellular carcinomas
(HCC) accumulate ICG.
Application image: D
r. R. Sutcliffe, Queen Elizabeth Hospital, UK
Page content: 2019, Boni et al., ICG-enhanced fluorescence-guided
laparoscopic surgery
Applications in General Surgery 11
Ureter Localization
Purpose: Injection time:
Visualization of the ureter Prior to the procedure
Injection type: First ICG detection:
Via a ureter catheter With start of procedure
filled with ICG
Used dosage: ICG duration:
5 mg/ml Remains stable during
surgery
Page content and application image:
Prof. L. Boni, Policlinico Milano, Italy
Applications in General Surgery
Thyroidectomy (Open Surgery)
Purpose: Injection time:
Visualization of the -
autofluorescence of
parathyroid glands
Injection type: First ICG detection:
No injection With start of surgery
(autofluorescence)
Used dosage: ICG duration:
- Remains stable
during surgery
Note:
In order to check the perfusion
of the parathyroid glands, ICG
can be injected intravenously.
Application image: P
rof. T. Carus, Elisabeth-Krankenhaus,
Thuine, Germany
Page content: 2019, Lerchenberger et al., Intraoperative Near-Infrared
Autofluorescence and Indocyanine Green Imaging to
Identify Parathyroid Glands: A Comparison
Applications in General Surgery 13
Colorectal and Gastrointestinal Carcinoma
Purpose: Injection time:
Visualization of lymphatic At least 10-15 min.
drainage and sentinel prior to procedure
lymph node
Injection type: First ICG detection:
Into the peritumoral With start of procedure
area
Used dosage: ICG duration:
0.5-1 ml on each Remains stable during
quadrant of the tumor surgery as it diffuses
(1.25 mg/ml slowly through the
concentration) lymphatics
Application image: Prof. L. Boni, Policlinico Milano, Italy
Page content: 2
019, Boni et al., ICG-enhanced fluorescence-guided
laparoscopic surgery
Applications in Gynecology
Cervical/Endometrial Cancer
Purpose: Injection time:
Visualization of lymphatic By the time trocars
drainage and sentinel get placed
lymph nodes
Injection type: First ICG detection:
Into the cervical With start of procedure
submucosa and deep
into the stroma
Used dosage: ICG duration:
Approx. 6 ml into the Remains stable during
four cervical quadrants surgery as it diffuses
(2.5 mg/ml concentration) slowly through the
lymphatics
Application image: Prof. M. Müller, Inselspital, Bern, Switzerland
Page content: 2016, Mueller et al., Sentinel-Lymphknotenmapping mit
NIR/ICG-Fluoreszenzbildgebung bei malignen Tumoren
in der Gynäkologie
Applications in Gynecology 15
Vulvar Cancer (Open Surgery)
Purpose: Injection time:
Visualization of lymphatic With start of surgery
drainage and sentinel
lymph nodes
Injection type: First ICG detection:
Peritumoral; superficially After 10 min.
and at a depth of about
1 cm
Used dosage: ICG duration:
(2.5 mg/ml Remains stable during
concentration) surgery as it diffuses
slowly through the
lymphatics
Application image: Prof. M. Müller, Inselspital, Bern, Switzerland
Page content: 2
016, Mueller et al., Sentinel-Lymphknotenmapping mit
NIR/ICG-Fluoreszenzbildgebung bei malignen Tumoren
in der Gynäkologie
Applications in Gynecology
Mammary Cancer (Open Surgery)
Purpose: Injection time:
Visualization of lymphatic 30 min. prior to surgery
drainage and sentinel
lymph node
Injection type: First ICG detection:
Subcutaneously into the With start of surgery
periareolar region in each
quadrant
Used dosage: ICG duration:
0.5 ml into each quadrant Remains stable during
(3.33 mg in total) surgery as it diffuses
slowly through the
lymphatics
NIR/ICG image based on
the previous D-LIGHT P
technology.
Page content and application image:
2018, Papathemelis et al., Sentinel Lymph Node Biopsy in Breast
Cancer Patients by Means of Indocyanine Green Using the KARL STORZ
VITOM® Fluorescence Camera System
Applications in Urology 17
Prostate Cancer
Purpose: Injection time:
Visualization of lymphatic Prior to surgery
drainage and sentinel
lymph nodes
Injection type: First ICG detection:
Transrectal or With start of procedure
transperineal
Used dosage: ICG duration:
(2.5-5 mg/ml Remains stable during
concentration) surgery as it diffuses
slowly through the
lymphatics
Page content and application image:
Dr. M. Ramirez-Backhaus, IVO, Valencia, Spain
Applications in Thoracic Surgery
Thoracoscopic Segmentectomy
Purpose: Injection time:
Perfusion assessment Prior to procedure
to define segment
boundaries
Injection type: First ICG detection:
Intravenous 1-15 sec. after injection
Used dosage: ICG duration:
0.15 mg/kg 30-120 sec.
NIR/ICG image based on the
previous D-LIGHT P technology.
Page content and application image:
2018, Pischik et al., ICG/NIR-Fluorescence-Imaging for Thoracoscopic
Segmentectomy
Applications in ENT 19
Otorhinolaryngology
Purpose: Injection time:
Visualization of vascular Injection during the
structures (enhanced procedure
tumor margin detection)
Injection type: First ICG detection:
Intravenous Within 1-2 min.
Used dosage: ICG duration:
5 ml (concentration Up to 15 min.
1.67 mg/ml) (Duration not exceeded
in the cited work)
NIR/ICG image based on the
previous D-LIGHT P technology.
Page content and application image:
2016, Guntinas-Lichius et al., Near-Infrared Endoscopy with Indocyanine
Green in Otolaryngology
Applications in Pediatrics
Palomo Varicocelectomy
Purpose: Injection time: After
Visualization of the opening the posterior
lymphatics peritoneum covering the
inner spermatic vessels
Injection type: First ICG detection:
Into the testicle Quickly after injection
Used dosage: ICG duration:
2 ml (3.125 mg/ml) Remains stable during
surgery
Note:
Many NIR/ICG procedures that
are described for adults are also
applicable for pediatrics.
Page content and application image:
2019, Esposito et al., Clinical application and technical standardization
of indocyanine green (ICG) fluorescence imaging in pediatric minimally
invasive surgery
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96261020 FI 7 1.0 01/2021/PGF-E
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