The Role and Significance of ICG Technologies in Emergency Surgery

ICG navigation in surgery is an intraoperative fluorescence imaging technology that helps the surgeon better visualize anatomical structures in real time. The method is particularly in demand in emergency surgery and during laparoscopic cholecystectomy, when inflammation, edema, and adhesions make orientation within the surgical field difficult. By using indocyanine green (ICG), it becomes possible to increase surgical precision, reduce the risk of bile duct injury, and improve the safety of the surgical intervention.

This technology is especially important in emergency surgery, where the risk of anatomical errors, inflammatory changes, and technical difficulties is significantly higher than in elective procedures. It is in this field that fluorescence navigation demonstrates not only clinical but also organizational value: it helps standardize the surgical process, improve the reproducibility of outcomes, and reduce the likelihood of complications.

Emergency surgery imposes heightened demands on the speed, accuracy, and reliability of visual control. In conditions of inflammation and altered tissues, intraoperative fluorescence imaging becomes an essential tool for reducing surgical risks:

• Enhances the accuracy of identifying anatomical structures;

• Improves the safety of laparoscopic interventions;

• Reduces the likelihood of iatrogenic injuries;

• Facilitates the performance of surgeries in technically complex cases.

Overcoming Barriers and Implementing Domestic Developments

For a long time, technical and economic factors remained major obstacles to the adoption of ICG navigation. A key problem was the need to administer the drug 6–8 hours before surgery, which complicated the use of the method in emergency settings. Additionally, the large-dose formulation of indocyanine green was expensive and did not fit well within compulsory health insurance (OMS) tariffs. An important direction in the development of this technology has been the emergence of domestically produced indocyanine green and Russian endoscopic imaging systems.

Innovations in Drugs and Techniques

Specifically, the fluorescence navigation technique for laparoscopic cholecystectomy has been improved, including fluorescence windows (Leonovich A.M., Klimov A.E., Kosachenko M.V., Barkhudarov A.A., Gogichashvili V.V., Safronova D.G., Aliev E.S., Burlakova A.V. Selection of optimal indocyanine green dosage in laparoscopic cholecystectomy for acute calculous cholecystitis. Annals of Surgical Hepatology. 2026;31(1):77-83. https://doi.org/10.16931/1995-5464.2026-1-77-83). Furthermore, a registration certificate has been obtained for the 5 mg formulation of indocyanine green. This has made the technology more flexible for real-world clinical practice and more accessible for widespread use.

The effectiveness of this method has been legally and scientifically validated: the technology is based on Patent No. 2860077, "Method for Intraoperative Visualization of Extrahepatic Bile Ducts during Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis." The developers of this innovation are recognized experts A.M. Leonovich, A.E. Klimov, A.A. Barkhudarov, and M.V. Kosachenko.

Another important step has been the emergence of the domestic endoscopic ICG system "ELEPS." It is approximately twice as cheap as imported alternatives, offers fast delivery times, and is supported by its own service network.

The ELEPS 4K ICG Endoscopic Visualization System (CTRU 26.60.12.119-00000374) is the first domestic high-tech complex that combines ultra-high 4K resolution with near-infrared (NIR/ICG) fluorescence navigation technology. The ELEPS development is expert-class equipment that fully complies with the import substitution program and global safety standards.

Economic and Operational Advantages

The use of domestic solutions offers benefits in terms of cost, logistics, service support, and adaptation to the conditions of the Russian healthcare system. This is particularly important for the large-scale implementation of the technology in both emergency and elective surgery.

Clinical Efficacy and Practical Value of the Method

Based on the results of a comprehensive analysis of over 1,100 laparoscopic cholecystectomy procedures using indocyanine green navigation, conducted across 23 healthcare institutions of varying levels, important practical conclusions have been drawn. The study included cases of acute, chronic, and complicated cholecystitis, allowing the effectiveness of the technology to be assessed in real-world clinical conditions, rather than within a narrow selective protocol.

Scientific and Expert Perspective on ICG Technology

For modern healthcare, this is especially important: the adoption of technologies must be based not only on their apparent effectiveness but also on evidence base, total cost of ownership, accessibility, and scalability.

ICG navigation is particularly justified in emergency surgery, where accuracy, safety, and speed of decision-making are paramount. Thanks to the availability of affordable domestic ELEPS systems and Aisgrin drugs, ICG navigation is transforming from a highly specialized innovation into a practical standard for safe surgery.